CA2925057A1 - Methods of treating and diagnosing alpha-v-beta-6 overexpressing cancer - Google Patents

Abstract

The disclosure relates in some aspects to methods of treating and diagnosing a Vß6 overexpressing cancer. In some embodiments, the disclosure relates to methods of treating and diagnosing a Vß6 and HER2 overexpressing cancer. In some embodiments, combination therapy strategies are employed.

Description

METHODS OF TREATING AND DIAGNOSING OW OVEREXPRESSING
CANCER
DESCRIPTION
Field [001] The field relates, in some aspects, to methods of treating and diagnosing aVI36 overexpressing cancer. In some embodiments, the field relates to methods of treating and diagnosing aVI36 and HER2 overexpressing cancer. In some embodiments, combination therapy strategies are employed.
Background

[002] Some of the most aggressive and invasive subtypes of breast cancer are those that overexpress Human Epidermal Growth Factor Receptor 2 (HER2), a member of the receptor tyrosine kinase family of receptors comprising of HER1-HER4.
HER2 is overexpressed in 25-30% of breast cancer and is responsible for imparting a more invasive phenotype to breast cancer cells although the actual mechanisms are not fully known. The introduction of the humanized antibody trastuzumab, which blocks downstream signaling from HER2, has resulted in reductions in recurrence and mortality of HER2-positive (HER2+) breast cancer patients. Unfortunately, over 70% of patients either have de novo, or develop, resistance to trastuzumab leaving these patients without molecular-specific treatment options. Thus, identifying improved therapies for women with HER2+ breast cancer is required urgently.

[003] Several studies have implicated dysregulation of the P13K/Akt pathway as a resistance mechanism in HER2+ breast cancer. Akt, however, is involved in many non-cancer related pathways hence inhibition may lead to many off-target and potentially undesirable effects, therefore a more cancer-specific target is desired. Thus, additional mechanisms of how HER2 actually promotes invasion and how the up-regulation of signaling promotes trastuzumab-resistance must be discovered.

[004] lntegrins are c43 heterodimeric transmembrane cell-surface receptors for extracellular proteins including some cell-surface proteins. They integrate the extracellular environment with the intracellular cytoskeletal and signaling machinery, transducing spatial-temporal messages that modulate cell behavior. Thus, integrins are central components of most normal cell processes including adhesion, migration, growth, survival and differentiation. Dysregulation of integrin expression and or signaling correlate with development of cancer through inappropriately regulating the processes SUBSTITUTE SHEET (RULE 26) only by epithelial cells, usually is only detectable on cells undergoing tissue-remodeling as occurs in wound healing, development, chronic inflammation and cancer.
Involvement, however, of integrins, such as aVI36, in certain cancers, especially breast cancer, has not yet been elucidated.
SUMMARY

[005] It has presently been shown that aVI36 may promote a more aggressive phenotype in breast cancer and offers a novel therapeutic target, in some embodiments for patients with trastuzumab-resistance.

[006] It is accordingly an object to detect and treat cancer cells that are sensitive to aVI36 inhibition, including, but not limited to, breast cancer and breast cancers resistant to trastuzumab. It is also an object to detect and treat cancer cells that are sensitive to both aVI36 and HER2 inhibition, including, but not limited to, breast cancer and breast cancers resistant to trastuzumab.

[007] One aspect includes, a method of treating a malignant tumor in an animal comprising administering to said animal in need thereof a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36; and b. optionally a combination therapy agent.

[008] Another aspect includes a method of inhibiting growth of tumor cells comprising administering to the tumor cells a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36; and b. optionally a combination therapy agent.

[009] A further aspect includes a method of suppressing growth of trastuzumab-resistant tumor cells comprising administering to said cells a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

SUBSTITUTE SHEET (RULE 26)

[010] Yet another aspect includes a method of diagnosing breast cancer sensitive to aVI36 and HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of tumor cells overexpressing aVI36 and HER2 by measuring the expression levels of aVI36 and HER2, wherein the patient is diagnosed with breast cancer sensitive to aVI36 and HER2 inhibition if aVI36 and HER2 are both overexpressed.

[011] A further embodiment includes a method for diagnosing and treating cancer sensitive to aVI36 inhibition in a patient comprising analyzing a patient sample for the presence or absence of cancer cells overexpressing aVI36 by measuring the levels of aVI36, wherein the patient is diagnosed with cancer sensitive to aVI36 inhibition if aVI36 is overexpressed, and administering to the diagnosed patient a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36.

[012] Moreover, one embodiment includes a method for diagnosing and treating breast cancer sensitive to HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of breast cancer cells overexpressing aVI36 and HER2 by measuring the levels of the aVI36 and HER2, wherein the patient is diagnosed with breast cancer sensitive to aVI36 and HER2 inhibition if both aVI36 and HER2 are overexpressed, and administering to the diagnosed patient a therapeutically effective dose of:
a. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

[013] Another embodiment includes a method for diagnosing and treating breast cancer sensitive to aVI36 and HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of breast cancer cells overexpressing aVI36 and HER2 by measuring the levels of the aVI36 and HER2, wherein the patient is diagnosed with breast cancer sensitive to aVI36 and HER2 inhibition if both aVI36 and HER2 are overexpressed, and administering to the diagnosed patient a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

SUBSTITUTE SHEET (RULE 26)

[014] A further aspect includes method for treating cancer sensitive to aVI36 inhibition in a patient sample comprising requesting a test to determine whether a patient sample contains cancer cells overexpressing aVI36, and administering a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36 if the patient sample contains cancer cells overexpressing aVI36.

[015] Yet an additional aspect includes a method for treating breast cancer sensitive to aVI36 and HER2 inhibition in a patient sample comprising requesting a test to determine whether a patient sample contains cancer cells overexpressing aVI36 and HER2, and administering a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2 if the patient sample contains cancer cells overexpressing aVI36 and HER2.

[016] An additional embodiment includes a method for diagnosing cancer sensitive to aVI36 inhibition in a patient that can be treated by inhibiting aVI36 comprising:
a. obtaining a biological sample from the subject;
b. applying an aVI36 targeted binding agent that specifically binds to aVI36 to the sample, wherein the presence of aVI36 creates a aVI36 targeted binding agent-aVI36 complex;
c. diagnosing an aggressive form of breast cancer where the complex of step b) is detected at a level indicating aVI36 overexpression.

[017] Another aspect includes a method for diagnosing breast cancer sensitive to aVI36 and HER2 inhibition in a patient that can be treated by inhibiting aVI36 and HER2 comprising:
a. obtaining a biological sample from the subject;
b. applying an aVI36 targeted binding agent that specifically binds to aVI36 to the sample, wherein the presence of aVI36 creates a aVI36 targeted binding agent-aVI36 complex;

SUBSTITUTE SHEET (RULE 26) c. optionally applying a HER2 targeted binding agent that specifically binds to HER2 to the sample, wherein the presence of HER2 creates a HER2 binding agent-HER2 complex; and d. diagnosing an aggressive form of breast cancer where the complexes of steps b) and c) are detected at a level indicating aVI36 and HER2 overexpression.

[018] Additional objects and advantages will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice. The objects and advantages will be realized and attained by means of the elements and combinations particularly pointed out in the appended claims.

[019] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the claims.

[020] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate one (several) embodiment(s) and together with the description, serve to explain the principles described herein.
BRIEF DESCRIPTION OF THE DRAWINGS

[021] Figures 1A-F are entitled "High co-expression of integrin aVI36 and HER2 predict poor survival in breast cancer patients." Kaplan-Meier curves by integrin aVI36 expression status. Tick marks indicate patients who were still alive at the time of analyses or who were censored. All P values refer to log-rank tests. (A) Normal and (B) cancerous breast cancer tissue sections immunohistochemically stained for integrin aVI36 (brown staining) using 6.2G2 antibody (Biogen Idec). Overall survival in 2 cohorts of breast cancer patients from London (C) and Nottingham (D) by integrin aVI36 status (high expression in red, low in black). The P value for patients with high integrin aVI36 versus low expression in tumors is <0.00001. (E) Overall survival of HER2+ patients from the combined London and Nottingham patient cohorts by integrin aVI36 status. The P
value for patients with high integrin aVI36 status versus low tumors is <0.001. (F) Overall survival of HER2+ patients from the METABRIC cohort by integrin aVI36 status.
The survival of patients with high ITGB6 expressing tumors versus low expressing tumors is significantly lower (P=0.003). Please also see Figures 10 and 11.

[022] Figures 2A-G are entitled "Breast cancer cell line invasion is both integrin aVI36 and HERIdependent." (A) Expression of integrin aVI36 and HER2 in a SUBSTITUTE SHEET (RULE 26) breast cancer cell line panel assessed by flow cytometry. lsotype controls are shown in black, integrin aVP6 in blue and HER2 expression in red (see Figure 12 for full panel of cell lines analyzed). (B) Transwell invasion assay of breast cancer cell lines expressing varying levels of integrin aVP6 and HER2. 5 x 104 cells/well were seeded and the number of cells that invaded was counted after 72h. (C) & (D), Breast cancer cell line invasion is integrin aVP6-dependent. Cells were subjected to either 30 min incubation with IgG or aVP6 blocking antibody (P6 Ab)(101Jg/m1) (C) or 72h transfection with control or J36 siRNA (201JM) (D) and subject to a transwell invasion assay as before. (E) &
(F), Breast cancer cell line invasion is HER2-dependent. Cells were pre-treated for 30 min with IgG
or Trastuzumab (TRA) (1 014/m1) (E) or transfected for 72h with control or siRNA (201JM) (F) and subject to a transwell invasion assay. (G) Cells were pre-treated for 30 min with IgG, P6 Ab, TRA (all 101Jg/m1) or a combination of the blocking antibodies & subject to a transwell invasion assay. All experiments were performed in triplicate, representative experiments shown (n=6 SD). * P=0.05, **P=0.01, ***P<0.001.
Please also see Figure 7.

[023] Figures 3A-C are entitled "HER2-driven invasion is integrin aVP6-dependent. Transwell invasion assay of cell lines overexpressing integrin aVP6 and HER2." Cells were pre-treated for 30 min with IgG, HRGP (1 1AM) in the presence and absence of aVP6 blocking antibody (10 [tg/m1) (A) or trastuzumab (TRA) (10 [tg/m1) (B) and 5 x 104 cells/well seeded into a Transwell invasion assay. The number of cells invaded was counted after 72h. All experiments were performed in triplicate, representative experiments shown (n=6 SD). * P =0.05, **P=0.01, ***P<0.001.
(C) Organotypic invasion of MCF10.CA1a (CAla) cell line. Cells were pre-treated for 30 min with IgG, aVP6 blocking antibody or TRA (10 [tg/m1) or transfected with siRNA to aVP6 or HER2 for 72h (20 1AM) prior to seeding. 5 x 104 cells were seeded on top of a collagen:Matrigel gel containing MRC5/hTERT fibroblasts. Gels were fixed in formal saline after 5-7 days incubation. Gels were paraffin embedded, sectioned and sections subject to H&E staining. Magnification bar = 10 1AM. Histograms quantify the invasion of each cell with the aforementioned treatments as invasion index. Experiments were performed in triplicate (n=2/experiment), representative experiments shown. *
P=0.05, **P=0.01, ***P<0.001.

[024] Figures 4A-G are entitled "Breast cancer xenograft growth is aVP6-dependent." (A) Mice bearing human BT -474 tumors were treated with IgG
(black), SUBSTITUTE SHEET (RULE 26) 264RAD (blue), trastuzumab (TRA) (red) or 264RAD+TRA (green)(10 mg/kg; i.p) twice weekly for 2 consecutive weeks. Data are presented as mean tumor volume SEM
(n>4 mice/group). Treatment commenced when tumors reached 100mm3. (B) Mice bearing human HER2-18 tumors were treated as in (A). (C) Photographic images of representative BT -474 and HER2-18 xenografts posttreatment outlined in (A).
Magnification bar=5mm. (D) BT -474 xenograft protein expression. Xenografts were treated as in (A), harvested, protein extracted and subject to immunoblotting.
Blots were probed for indicated proteins. (E) Histograms of relative protein expression from blots shown in (D) determined by optical density (n=3 individual tumors SEM).
*P=0.05, ***P<0.001. (F & G) HER2-18 xenograft protein expression and quantification as outlined in (D & E).

[025] Figure 5 is entitled "264RAD enhances the anti-tumorigenicity of trastuzumab and inhibits human xenograft MCF-7/HER2-18 cell growth, prolongs survival and reduces aV136, HER2, HER3, Akt2 and Smad2 in SCID mice." Mice bearing human MCF-7/HER2-18 tumors were treated with IgG (black), 264RAD (blue), trastuzumab (TRA) (red) or 264RAD+TRA (green) (10mg/kg; i.p) twice weekly for consecutive weeks. Data are presented as mean tumor volume SEM (n>5 mice/group).
Treatment commenced when tumors were 4mm in any one dimension (A), and when tumors reached 200mm3 (n>6 mice/group) (B). (C) Kaplan-Meier survival plot shows survival of mice from study of larger tumors shown in (B). (D) Tumors from treated mice in (A) were analyzed by immunoblotting for indicated targets (combination therapy treated xenografts were eradicated hence were unavailable for analysis). Actin immunoblot shows equal protein input. (E) Histogram quantifying changes in protein expression levels from (D) (13-actin corrected). (F) Immunohistochemical analysis of aV136 expression in HER2-18 tumor xenografts. Xenografts were fixed, sectioned and stained for P6 expression after 6 weeks treatment as outlined in (A) or for 2 weeks with 264RAD+trastuzumab (264RAD+TRA). Magnification bar=101JM.

[026] Figures 6A-D are entitled "High co-expression of integrin aV136 and HER2 predict poor long-term survival in breast cancer patients." Kaplan-Meier curves by integrin aV136 expression status. The tick marks indicate patients who were still alive at the time of the analyses or who were censored. All P values refer to log-rank tests. 15-year overall survival of breast cancer patients from London (A) and Nottingham (B) cohorts by integrin aV136 status. The P value for patients with high integrin aV136 (red) SUBSTITUTE SHEET (RULE 26) versus low expression (black) in tumors is P=0.006 and P=0.002 respectively.
(C) 15-year overall survival of HER2-positive patients from the combined London and Nottingham patient cohorts by integrin aVI36 status. The P value for patients with high integrin aVI36 status versus low tumors is < 0.001. (D) 15-year overall survival of HER2-positive patients from the METABRIC cohort by ITGB6 gene status. The P value for patients with high integrin aVI36 status versus low expression tumors is P=0.048.

[027] Figures 7A-C are as follows. (A) 264RAD is as effective as 1005 aVI36 blocking antibody at inhibiting invasion in HER2-18 and CAla cells. Cells overexpressing integrin aVI36and HER2 were pre-treated for 30 min with IgG, or aVI36 blocking antibodies 1005 or 264RAD (10 [tg/m1) and 5 x 104 cells/well seeded into a transwell invasion assay. The number cells invaded was counted after 72h. All experiments were performed in triplicate, representative experiments shown (n=6 SD).
**P=0.01, ***P<0.001. (B) Proliferation was unaffected by aVI36 and/or HER2 antibody blockade over 7 days. 0.5-2 x 103 cells/well were seeded 24h prior to 48h growth in double-charcoal stripped FCS media. After 48h, cells were treated for 7 days with IgG, aVI36 blocking antibody 264RAD, trastuzumab (TRA) (all 10 [tg/m1) or a combination of the blocking antibodies. Cells were subject to the MTS assay after 7 days and 'proliferation' (representing mitochondrial activity) plotted relative to day 7 IgG
treated cells. All experiments were performed in triplicate, representative experiments shown (n=6 SD). (C) aVI36 and HER2 co-localize in the cell membrane. MCF-18 (HER2-18) and MCF10.CA1a (CAla) cells were labeled with aVI36 in red (1005, Millipore) and HER2 in green (Cell Signaling Technology) antibodies with secondary conjugates of Alexa-488 and A1exa647 respectively. Nuclear staining was performed using DAPI (blue). Samples were imaged on a Zeiss LSM710 confocal microscope.
Magnification bar= 10 1AM.

[028] Figure 8 is entitled "Invasion is not TGFI3-dependent and blockade of aVI36 inhibits invasion in the presence and absence of TGFI3 ligand or TGFI3RII in vitro."
Transwell Matrigel invasion assay of cell lines overexpressing integrin aVI36 and HER2.
Cells were subject to TGFI3RII siRNA treatment for 72h prior to treatment with (10 [tg/m1) in the presence and absence of TGFI3 (5ng/m1) and 5 x 104 cells/well seeded into a transwell invasion assay. The number cells invaded was counted after 72h. All experiments were performed in triplicate, representative experiments shown (n=6 SD).
*P=0.05, **P=0.01, ***P<0.001.

SUBSTITUTE SHEET (RULE 26)

[029] Figure 9 is entitled :lntegrin aVI36-dependent invasion is via Akt2."

Transwell invasion assay of cell lines overexpressing integrin aVI36 and HER2.
Cells were pre-treated for 72h transfection with control or Aktl, Akt2 or Aktl +2 siRNA
(20nM) (A) and 5 x 104 cells/well seeded into a Transwell invasion assay. The number of cells invaded was counted after 72h. All experiments were performed in triplicate, representative experiments shown (n=6 SD). Insert Representative immunoblot of siRNA protein knockdown. * P =0.05, **P=0.01. (B) Organotypic invasion of MCF10.CA la (CA la) cell line. Cells were pre-treated as in (A) prior to seeding. 5 x 104 cells were seeded on top of a collagen:Matrigel gel containing MRC5/hTERT
fibroblasts.
Gels were fixed in formal saline after 5-7 days incubation. Gels were paraffin embedded, sectioned and sections subject to H&E staining. Magnification bar = 10 1AM.
Histogram quantifies the invasion with the aforementioned treatments as invasion index.
Experiments were performed in triplicate (n=2/experiment), representative experiments shown.* P=0.05, **P=0.01.

[030] Figure 10 is a table entitled "clinicopathological characteristics of the London and Nottingham cohorts of breast cancer patients."

[031] Figure 11 is a table entitled "association of aVI36 with conventional prognostic indicators in breast cancer."

[032] Figure 12 is a table entitled "aVI36 and HER2 Expression and receptor status in a panel of breast cancer cell lines." Molecular Subtype & receptor status defined by Neve et al (2006) & Subik et al (2010). Invasive Propensity as determined by invasion through matrigel. Expression determined by flow cytometry as Mean fluorescence Intensity (MFI): 0-10 = -, 11-25 = +, 26-50 = ++, 51-100 = +++, >100 = ++++, ND, not determined.

[033] Figure 13 is a list of antibodies utilized in a study of aVI36 and expression in breast cancer.
[001] Figure 14 is a line graph showing the ability of the purified monoclonal antibodies to bind to aVI36 and block its binding to a GST-LAP
peptide.
[002] Figures 15A and B are line graphs showing a plot of the averaged Geometric Mean Fluorescence (GMF) as a function of molecular mAb concentration, which was used to estimate the binding affinity of one of the antibodies to K562 cells that SUBSTITUTE SHEET (RULE 26) stably express the human aVI36 antigen. Shown in Figure 15A is affinity data for mAb 188. Figure 15B shows affinity data for mAb 264 RAD.
[003] Figures 16A-E are bar graphs showing the ability of the purified monoclonal antibodies to mediate complement-dependent cytotoxicity in 293 cells stably expressing aVI36 integrin.
[004] Figure 17 is a bar graph showing the ability of antibodies 264RAD, 133 and 188 SDM to inhibit tumor growth using the Detroit-562 nasopharyngeal cell line.
[005] Figure 18 is a bar chart showing comparison of the activity of 264 RAD
with 264 RAD/ADY.
SEQUENCE LISTING
[006] Embodiments include the specific anti- aVI36 antibodies listed below in Table 1. This table reports the identification number of each anti- aVI36 antibody, along with the SEQ ID number of the variable domain of the corresponding heavy chain and light chain genes. Each antibody has been given an identification number that includes the letters "sc" followed by a number.
Table 1 SEQ
mAb ID Sequence ID
No.: NO:
Nucleotide sequence encoding the variable region of the heavy chain 1 sc 49 Amino acid sequence encoding the variable region of the heavy chain Nucleotide sequence encoding the variable region of the light chain 3 Amino acid sequence encoding the variable region of the light chain 4 Nucleotide sequence encoding the variable region of the heavy chain 5 sc 58 Amino acid sequence encoding the variable region of the heavy chain Nucleotide sequence encoding the variable region of the light chain 7 Amino acid sequence encoding the variable region of the light chain 8 Nucleotide sequence encoding the variable region of the heavy chain 9 sc 97 Amino acid sequence encoding the variable region of the heavy chain Nucleotide sequence encoding the variable region of the light chain 11 Amino acid sequence encoding the variable region of the light chain 12 Nucleotide sequence encoding the variable region of the heavy chain 13 sc 133 Amino acid sequence encoding the variable region of the heavy chain Nucleotide sequence encoding the variable region of the light chain 15 Amino acid sequence encoding the variable region of the light chain 16 Nucleotide sequence encoding the variable region of the heavy chain 17 sc 161 Amino acid sequence encoding the variable region of the heavy chain Nucleotide sequence encoding the variable region of the light chain 19 Amino acid sequence encoding the variable region of the light chain 20 SUBSTITUTE SHEET (RULE 26) SEQ
mAb ID Sequence ID
No.: NO:
Nucleotide sequence encoding the variable region of the heavy chain 21 Amino acid sequence encoding the variable region of the heavy chain 22 sc 188 Nucleotide sequence encoding the variable region of the light chain 23 Amino acid sequence encoding the variable region of the light chain 24 Nucleotide sequence encoding the variable region of the heavy chain 25 Amino acid sequence encoding the variable region of the heavy chain 26 sc 254 Nucleotide sequence encoding the variable region of the light chain 27 Amino acid sequence encoding the variable region of the light chain 28 Nucleotide sequence encoding the variable region of the heavy chain 29 Amino acid sequence encoding the variable region of the heavy chain 30 sc 264 Nucleotide sequence encoding the variable region of the light chain 31 Amino acid sequence encoding the variable region of the light chain 32 Nucleotide sequence encoding the variable region of the heavy chain 33 Amino acid sequence encoding the variable region of the heavy chain 34 sc 277 Nucleotide sequence encoding the variable region of the light chain 35 Amino acid sequence encoding the variable region of the light chain 36 Nucleotide sequence encoding the variable region of the heavy chain 37 Amino acid sequence encoding the variable region of the heavy chain 38 sc 298 Nucleotide sequence encoding the variable region of the light chain 39 Amino acid sequence encoding the variable region of the light chain 40 Nucleotide sequence encoding the variable region of the heavy chain 41 Amino acid sequence encoding the variable region of the heavy chain 42 sc 320 Nucleotide sequence encoding the variable region of the light chain 43 Amino acid sequence encoding the variable region of the light chain 44 Nucleotide sequence encoding the variable region of the heavy chain 45 Amino acid sequence encoding the variable region of the heavy chain 46 sc 374 Nucleotide sequence encoding the variable region of the light chain 47 Amino acid sequence encoding the variable region of the light chain 48 Nucleotide sequence encoding the variable region of the heavy chain 70 sc 188 Amino acid sequence encoding the variable region of the heavy chain SDM Nucleotide sequence encoding the variable region of the light chain Amino acid sequence encoding the variable region of the light chain 73 Nucleotide sequence encoding the variable region of the heavy chain 74 sc 264 Amino acid sequence encoding the variable region of the heavy chain RAD Nucleotide sequence encoding the variable region of the light chain Amino acid sequence encoding the variable region of the light chain 77 Nucleotide sequence encoding the variable region of the heavy chain 78 sc 133 Amino acid sequence encoding the variable region of the heavy chain TMT Nucleotide sequence encoding the variable region of the light chain Amino acid sequence encoding the variable region of the light chain 81 133 Nucleotide sequence encoding the variable region of the heavy chain sc WDS Amino acid sequence encoding the variable region of the heavy chain Nucleotide sequence encoding the variable region of the light chain 84 SUBSTITUTE SHEET (RULE 26) SEQ
mAb ID Sequence ID
No.: NO:
Amino acid sequence encoding the variable region of the light chain 85 133 Nucleotide sequence encoding the variable region of the heavy chain sc TMT/W Amino acid sequence encoding the variable region of the heavy chain DS Nucleotide sequence encoding the variable region of the light chain Amino acid sequence encoding the variable region of the light chain 89 Nucleotide sequence encoding the variable region of the heavy chain 90 sc 264 Amino acid sequence encoding the variable region of the heavy chain ADY Nucleotide sequence encoding the variable region of the light chain Amino acid sequence encoding the variable region of the light chain 93 264 Nucleotide sequence encoding the variable region of the heavy chain sc RAD/A Amino acid sequence encoding the variable region of the heavy chain DY Nucleotide sequence encoding the variable region of the light chain Amino acid sequence encoding the variable region of the light chain 97 DESCRIPTION OF THE EMBODIMENTS
[007] Reference will now be made in detail to the present embodiment(s) (exemplary embodiments), an example(s) of which is (are) illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
I. Definitions [008] Unless otherwise defined, scientific and technical terms used herein shall have the meanings that are commonly understood by those of ordinary skill in the art.
Further, unless otherwise required by context, singular terms shall include pluralities and plural terms shall include the singular. Generally, nomenclatures utilized in connection with, and techniques of, cell and tissue culture, molecular biology, and protein and oligo-or polynucleotide chemistry and hybridization described herein are those well-known and commonly used in the art.
[009] Standard techniques are used for recombinant DNA, oligonucleotide synthesis, and tissue culture and transformation (e.g., electroporation, lipofection).
Enzymatic reactions and purification techniques are performed according to manufacturer's specifications or as commonly accomplished in the art or as described herein. The foregoing techniques and procedures are generally performed according to conventional methods well known in the art and as described in various general and more SUBSTITUTE SHEET (RULE 26) specific references that are cited and discussed throughout the present specification. See e.g., Sambrook et al., Molecular Cloning: A Laboratory Manual (3rd ed., Cold Spring Harbor Laboratory Press, Cold Spring Harbor, N.Y. (2001)), which is incorporated herein by reference. The nomenclatures utilized in connection with, and the laboratory procedures and techniques of, analytical chemistry, synthetic organic chemistry, and medicinal and pharmaceutical chemistry described herein are those well-known and commonly used in the art. Standard techniques are used for chemical syntheses, chemical analyses, pharmaceutical preparation, formulation, and delivery, and treatment of patients.
[010] As utilized in accordance with the present disclosure, the following terms, unless otherwise indicated, shall be understood to have the following meanings:
[011] The term "and/or" as used herein is to be taken as specific disclosure of each of the two specified features or components with or without the other.
For example "A and/or B" is to be taken as specific disclosure of each of (i) A, (ii) B
and (iii) A and B, just as if each is set out individually herein.
[012] An antagonist may be a polypeptide, nucleic acid, carbohydrate, lipid, small molecular weight compound, an oligonucleotide, an oligopeptide, RNA
interference (RNAi), antisense, a recombinant protein, an antibody, or conjugates or fusion proteins thereof. For a review of RNAi see Milhavet 0, Gary DS, Mattson MP. (Pharmacol Rev.
2003 Dec;55(4):629-48. Review.) and antisense see Opalinska JB, Gewirtz AM.
(Sci STKE. 2003 Oct 28;2003 (206):pe47.) [013] Disease-related aberrant activation or expression of "aVI36" may be any abnormal, undesirable or pathological cell adhesion, for example tumor-related cell adhesion. Cell adhesion-related diseases include, but are not limited to, non-solid tumors such as leukemia, multiple myeloma or lymphoma, and also solid tumors such as melanoma, small cell lung cancer, non-small cell lung cancer, glioma, hepatocellular (liver) carcinoma, glioblastoma, carcinoma of the thyroid, bile duct, bone, gastric, brain/CNS, head and neck, hepatic system, stomach, prostate, breast, renal, testicle, ovary, skin, cervix, lung, muscle, neuron, oesophageal, bladder, lung, uterus, vulva, endometrium, kidney, colorectum, pancreas, pleural/peritoneal membranes, salivary gland, and epidermous.
[014] A compound refers to any small molecular weight compound with a molecular weight of less than about 2000 Daltons.

SUBSTITUTE SHEET (RULE 26) [015] The term "aVI36" refers to the heterodimer integrin molecule consisting of an aV chain and a P6 chain.
[016] The term "neutralizing" when referring to a targeted binding agent, such as an antibody, relates to the ability of said targeted binding agent to eliminate, or significantly reduce, the activity of a target antigen. Accordingly, a "neutralizing" anti-aV136 antibody is capable of eliminating or significantly reducing the activity of aVI36. A
neutralizing aV136 antibody may, for example, act by blocking the binding of TGFPLAP
to the integrin aVI36. By blocking this binding, aV136 mediated cell adhesion is significantly, or completely, eliminated. Ideally, a neutralizing antibody against aV136 inhibits cell adhesion.
[017] The term "isolated polynucleotide" as used herein shall mean a polynucleotide that has been isolated from its naturally occurring environment. Such polynucleotides may be genomic, cDNA, or synthetic. In some embodiments, isolated polynucleotides not associated with all or a portion of the polynucleotides they associate with in nature. The isolated polynucleotides may be operably linked to another polynucleotide that it is not linked to in nature. In addition, isolated polynucleotides may not occur in nature as part of a larger sequence.
[018] The term "isolated protein" referred to herein means a protein that has been isolated from its naturally occurring environment. Such proteins may be derived from genomic DNA, cDNA, recombinant DNA, recombinant RNA, or synthetic origin or some combination thereof, which by virtue of its origin, or source of derivation, the "isolated protein" (1) is not associated with proteins found in nature, (2) is free of other proteins from the same source, e.g. free of murine proteins, (3) is expressed by a cell from a different species, or (4) does not occur in nature.
[019] The term "polypeptide" is used herein as a generic term to refer to native protein, fragments, or analogs of a polypeptide sequence. Hence, native protein, fragments, and analogs are species of the polypeptide genus. Polypeptides may comprise the human heavy chain immunoglobulin molecules and the human kappa light chain immunoglobulin molecules, as well as antibody molecules formed by combinations comprising the heavy chain immunoglobulin molecules with light chain immunoglobulin molecules, such as the kappa or lambda light chain immunoglobulin molecules, and vice versa, as well as fragments and analogs thereof. Polypeptides may also comprise solely the human heavy chain immunoglobulin molecules or fragments thereof.

SUBSTITUTE SHEET (RULE 26) [020] The term "naturally-occurring" as used herein as applied to an object refers to the fact that an object can be found in nature. For example, a polypeptide or polynucleotide sequence that is present in an organism (including viruses) that can be isolated from a source in nature and which has not been intentionally modified by man in the laboratory or otherwise is naturally-occurring.
[021] The term "operably linked" as used herein refers to positions of components so described that are in a relationship permitting them to function in their intended manner. For example, a control sequence "operably linked" to a coding sequence is connected in such a way that expression of the coding sequence is achieved under conditions compatible with the control sequences.
[022] The term "polynucleotide" as referred to herein means a polymeric form of nucleotides of at least 10 bases in length, either ribonucleotides or deoxynucleotides or a modified form of either type of nucleotide, or RNA-DNA hetero-duplexes. The term includes single and double stranded forms of DNA.
[023] The term "oligonucleotide" referred to herein includes naturally occurring, and modified nucleotides linked together by naturally occurring, and non-naturally occurring linkages. Oligonucleotides are a polynucleotide subset generally comprising a length of 200 bases or fewer. Oligonucleotides may be 10 to 60 bases in length, in other embodiments, they may be 12, 13, 14, 15, 16, 17, 18, 19, or 20 to 40 bases in length. Oligonucleotides are usually single stranded, e.g. for probes; although oligonucleotides may be double stranded, e.g. for use in the construction of a gene mutant. Oligonucleotides can be either sense or antisense oligonucleotides.
[024] The term "naturally occurring nucleotides" referred to herein includes deoxyribonucleotides and ribonucleotides. The term "modified nucleotides"
referred to herein includes nucleotides with modified or substituted sugar groups and the like. The term "oligonucleotide linkages" referred to herein includes oligonucleotides linkages such as phosphorothioate, phosphorodithioate, phosphoroselenoate, phosphorodiselenoate, phosphoroanilothioate, phosphoraniladate, phosphoroamidate, and the like. See e.g., LaPlanche et al., Nucl. Acids Res. 14:9081 (1986); Stec et al., J. Am. Chem.
Soc.
106:6077 (1984); Stein et al., Nucl. Acids Res. 16:3209 (1988); Zon et al., Anti-Cancer Drug Design 6:539 (1991); Zon et al., Oligonucleotides and Analogues: A
Practical Approach, pp. 87-108 (F. Eckstein, Ed., Oxford University Press, Oxford England (1991)); Stec et al., U.S. Patent No. 5,151,510; Uhlmann and Peyman Chemical Reviews SUBSTITUTE SHEET (RULE 26) 90:543 (1990), the disclosures of which are hereby incorporated by reference.
An oligonucleotide can include a label for detection, if desired.
[025] The term "selectively hybridize" referred to herein means to detectably and specifically bind. Polynucleotides, oligonucleotides and fragments thereof selectively hybridize to nucleic acid strands under hybridization and wash conditions that minimize appreciable amounts of detectable binding to nonspecific nucleic acids. High stringency conditions can be used to achieve selective hybridization conditions as known in the art and discussed herein. Generally, the nucleic acid sequence homology between the polynucleotides, oligonucleotides, or antibody fragments and a nucleic acid sequence of interest will be at least 80%, and more typically with increasing homologies of at least 85%, 90%, 95%, 99%, and 100%.
[026] The term "CDR region" or "CDR" is intended to indicate the hypervariable regions of the heavy and light chains of the immunoglobulin as defined by Kabat et al., 1991 (Kabat, E.A. et al., (1991) Sequences of Proteins of Immunological Interest, 5th Edition. US Department of Health and Human Services, Public Service, NIH, Washington), and later editions. An antibody typically contains 3 heavy chain CDRs and 3 light chain CDRs. The term CDR or CDRs is used here in order to indicate, according to the case, one of these regions or several, or even the whole, of these regions which contain the majority of the amino acid residues responsible for the binding by affinity of the antibody for the antigen or the epitope which it recognizes.
[027] Among the six short CDR sequences, the third CDR of the heavy chain (HCDR3) has a greater size variability (greater diversity essentially due to the mechanisms of arrangement of the genes which give rise to it). It may be as short as 2 amino acids although the longest size known is 26. CDR length may also vary according to the length that can be accommodated by the particular underlying framework.

Functionally, HCDR3 plays a role in part in the determination of the specificity of the antibody (Segal et al., PNAS, 71:4298-4302, 1974, Amit et al., Science, 233:747-753, 1986, Chothia et al., J. Mol. Biol., 196:901-917, 1987, Chothia et al., Nature, 342:877-883, 1989, Caton et al., J. Immunol., 144:1965-1968, 1990, Sharon et al., PNAS, 87:4814-4817, 1990, Sharon et al., J. Immunol., 144:4863-4869, 1990, Kabat et al., J.
Immunol., 147:1709-1719, 1991).
[028] The term a "set of CDRs" referred to herein comprises CDR1, CDR2 and CDR3. Thus, a set of HCDRs refers to HCDR1, HCDR2 and HCDR3 (HCDR refers to a SUBSTITUTE SHEET (RULE 26) variable heavy chain CDR) , and a set of LCDRs refers to LCDR1, LCDR2 and (LCDR refers to a variable light chain CDR). Unless otherwise stated, a "set of CDRs"
includes HCDRs and LCDRs.
[029] Two amino acid sequences are "homologous" if there is a partial or complete identity between their sequences. For example, 85% homology means that 85%
of the amino acids are identical when the two sequences are aligned for maximum matching. Gaps (in either of the two sequences being matched) are allowed in maximizing matching; gap lengths of 5 or less are used in some embodiments, with 2 or less being used in other embodiments. Alternatively, two protein sequences (or polypeptide sequences derived from them of at least about 30 amino acids in length) are homologous, as this term is used herein, if they have an alignment score of at more than 5 (in standard deviation units) using the program ALIGN with the mutation data matrix and a gap penalty of 6 or greater. See Dayhoff, M.O., in Atlas of Protein Sequence and Structure, pp. 101-110 (Volume 5, National Biomedical Research Foundation (1972)) and Supplement 2 to this volume, pp. 1-10. The two sequences or parts thereof are homologous if their amino acids are greater than or equal to 50% identical when optimally aligned using the ALIGN program. It should be appreciated that there can be differing regions of homology within two orthologous sequences. For example, the functional sites of mouse and human orthologues may have a higher degree of homology than non-functional regions.
[030] The term "corresponds to" is used herein to mean that a polynucleotide sequence is homologous (i.e., is identical, not strictly evolutionarily related) to all or a portion of a reference polynucleotide sequence, or that a polypeptide sequence is identical to a reference polypeptide sequence.
[031] In contradistinction, the term "complementary to" is used herein to mean that the complementary sequence is homologous to all or a portion of a reference polynucleotide sequence. For illustration, the nucleotide sequence "TATAC"
corresponds to a reference sequence "TATAC" and is complementary to a reference sequence "GTATA."
[032] The term "sequence identity" means that two polynucleotide or amino acid sequences are identical (i.e., on a nucleotide-by-nucleotide or residue-by-residue basis) over the comparison window. The term "percentage of sequence identity"
is calculated by comparing two optimally aligned sequences over the window of SUBSTITUTE SHEET (RULE 26) comparison, determining the number of positions at which the identical nucleic acid base (e.g., A, T, C, G, U, or I) or amino acid residue occurs in both sequences to yield the number of matched positions, dividing the number of matched positions by the total number of positions in the comparison window (i.e., the window size), and multiplying the result by 100 to yield the percentage of sequence identity. The terms "substantial identity" as used herein denotes a characteristic of a polynucleotide or amino acid sequence, wherein the polynucleotide or amino acid comprises a sequence that has at least 85 percent sequence identity, at least 90 to 95 percent sequence identity, or at least 99 percent sequence identity, as compared to a reference sequence over a comparison window of at least 18 nucleotide (6 amino acid) positions, frequently over a window of at least 24-48 nucleotide (8-16 amino acid) positions, wherein the percentage of sequence identity is calculated by comparing the reference sequence to the sequence which may include deletions or additions which total 20 percent or less of the reference sequence over the comparison window. The reference sequence may be a subset of a larger sequence.
[033] As used herein, the twenty conventional amino acids and their abbreviations follow conventional usage. See Immunology - A Synthesis (2nd Edition, E.S.
Golub and D.R. Gren, Eds., Sinauer Associates, Sunderland, Mass. (1991)), which is incorporated herein by reference. Stereoisomers (e.g., D-amino acids) of the twenty conventional amino acids, unnatural amino acids such as a-, a-disubstituted amino acids, N-alkyl amino acids, lactic acid, and other unconventional amino acids may also be suitable components for polypeptides herein. Examples of unconventional amino acids include: 4-hydroxyproline, y-carboxyglutamate, E-N,N,N-trimethyllysine, E-N-acetyllysine, 0-phosphoserine, N-acetylserine, N-formylmethionine, 3-methylhistidine, 5-hydroxylysine, a-N-methylarginine, and other similar amino acids and imino acids (e.g., 4-hydroxyproline). In the polypeptide notation used herein, the left-hand direction is the amino terminal direction and the right-hand direction is the carboxy-terminal direction, in accordance with standard usage and convention.

[034] Similarly, unless specified otherwise, the left-hand end of single-stranded polynucleotide sequences is the 5' end; the left-hand direction of double-stranded polynucleotide sequences is referred to as the 5' direction. The direction of 5' to 3' addition of nascent RNA transcripts is referred to as the transcription direction; sequence regions on the DNA strand having the same sequence as the RNA and which are 5' to the SUBSTITUTE SHEET (RULE 26) 5' end of the RNA transcript are referred to as "upstream sequences"; sequence regions on the DNA strand having the same sequence as the RNA and which are 3' to the 3' end of the RNA transcript are referred to as "downstream sequences".

[035] As applied to polypeptides, the term "substantial identity" means that two peptide sequences, when optimally aligned, such as by the programs GAP or BESTFIT using default gap weights, share at least 80 percent sequence identity, at least 90 percent sequence identity, at least 95 percent sequence identity, or at least 99 percent sequence identity. Residue positions that are not identical differ by conservative amino acid substitutions. Conservative amino acid substitutions refer to the interchangeability of residues having similar side chains. For example, a group of amino acids having aliphatic side chains is glycine, alanine, valine, leucine, and isoleucine; a group of amino acids having aliphatic-hydroxyl side chains is serine and threonine; a group of amino acids having amide-containing side chains is asparagine and glutamine; a group of amino acids having aromatic side chains is phenylalanine, tyrosine, and tryptophan; a group of amino acids having basic side chains is lysine, arginine, and histidine; and a group of amino acids having sulfur-containing side chains is cysteine and methionine.
Conservative amino acids substitution groups are: valine-leucine-isoleucine, phenylalanine-tyrosine, lysine-arginine, alanine-valine, glutamic-aspartic, and asparagine-glutamine.

[036] As discussed herein, minor variations in the amino acid sequences of antibodies or immunoglobulin molecules are contemplated, providing that the variations in the amino acid sequence maintain at least about 75%, at least 80%, 90%, 95%, or about 99% sequence identity to the antibodies or immunoglobulin molecules described herein.
In particular, conservative amino acid replacements are contemplated.
Conservative replacements are those that take place within a family of amino acids that have related side chains. Genetically encoded amino acids are generally divided into families: (1) acidic=aspartate, glutamate; (2) basic=lysine, arginine, histidine; (3) non-polar=alanine, valine, leucine, isoleucine, proline, phenylalanine, methionine, tryptophan;
and (4) uncharged polar=glycine, asparagine, glutamine, cysteine, serine, threonine, tyrosine. In one embodiment, families are: serine and threonine are an aliphatic-hydroxy family;
asparagine and glutamine are an amide-containing family; alanine, valine, leucine and isoleucine are an aliphatic family; and phenylalanine, tryptophan, and tyrosine are an aromatic family. For example, it is reasonable to expect that an isolated replacement of a leucine with an isoleucine or valine, an aspartate with a glutamate, a threonine with a SUBSTITUTE SHEET (RULE 26) serine, or a similar replacement of an amino acid with a structurally related amino acid will not have a major effect on the binding function or properties of the resulting molecule, especially if the replacement does not involve an amino acid within a framework site.

[037] Whether an amino acid change results in a functional peptide can readily be determined by assaying the specific activity of the polypeptide derivative.
Assays are described in detail herein. Fragments or analogs of antibodies or immunoglobulin molecules can be readily prepared by those of ordinary skill in the art. In one embodiment, amino- and carboxy-termini of fragments or analogs occur near boundaries of functional domains. Structural and functional domains can be identified by comparison of the nucleotide and/or amino acid sequence data to public or proprietary sequence databases. Computerized comparison methods are used to identify sequence motifs or predicted protein conformation domains that occur in other proteins of known structure and/or function. Methods to identify protein sequences that fold into a known three-dimensional structure are known. Bowie et al., (1991) Science 253:164. Thus, the foregoing examples demonstrate that those of skill in the art can recognize sequence motifs and structural conformations that may be used to define structural and functional domains in accordance with the antibodies described herein.

[038] A further aspect is a targeting binding agent or an antibody molecule comprising a VH domain that has at least about 60, 70, 80, 85, 90, 95, 98 or about 99%
amino acid sequence identity with a VH domain of any of antibodies shown in Table 1, the appended sequence listing, an antibody described herein, or with an HCDR
(e.g., HCDR1, HCDR2, or HCDR3) shown in Table 8 or Table 29. The targeting binding agent or antibody molecule may optionally also comprise a VL domain that has at least about 60, 70, 80, 85, 90, 95, 98 or about 99% amino acid sequence identity with a VL
domain any of antibodies shown in Table 1, the appended sequence listing, an antibody described herein, or with an LCDR (e.g., LCDR1, LCDR2, or LCDR3) shown in Table 9 or Table 30. Algorithms that can be used to calculate % identity of two amino acid sequences comprise e.g. BLAST (Altschul et al., (1990) J. Mol. Biol. 215: 405-410), FASTA
(Pearson and Lipman (1988) PNAS USA 85: 2444-2448), or the Smith-Waterman algorithm (Smith and Waterman (1981) J. Mol Biol. 147: 195-197), e.g.
employing default parameters. In some embodiments, the targeting binding agent or antibody that shares amino acid sequence identity as describes above, exhibits substantially the same SUBSTITUTE SHEET (RULE 26) activity as the antibodies referenced. For instance, substantially the same activity comprises at least one activity that differed from the activity of the references antibodies by no more that about 50%, 40%, 30%, 20%, 10%, 5%, 2%, 1% or less.

[039] An antigen binding site is generally formed by the variable heavy (VH) and variable light (VL) immunoglobulin domains, with the antigen-binding interface formed by six surface polypeptide loops, termed complimentarity determining regions (CDRs). There are three CDRs in each VH (HCDR1, HCDR2, HCDR3) and in each VL
(LCDR1, LCDR2, LCDR3), together with framework regions (FRs).

[040] Typically, a VH domain is paired with a VL domain to provide an antibody antigen-binding site, although a VH or VL domain alone may be used to bind antigen. The VH domain (e.g. from Table 1) may be paired with the VL domain (e.g.
from Table 1), so that an antibody antigen-binding site is formed comprising both the VH
and VL domains. Analogous embodiments are provided for the other VH and VL
domains disclosed herein. In other embodiments, VH chains in Table 8 or Table 29 are paired with a heterologous VL domain. Light-chain promiscuity is well established in the art. Again, analogous embodiments are provided for the other VH and VL domains disclosed herein. Thus, the VH of the parent or of any of antibodies chain on Table 9 or Table 30 may be paired with the VL of the parent or of any of antibodies on Table 1 or other antibody.

[041] An antigen binding site may comprise a set of H and/or L CDRs of the parent antibody or any of antibodies in Table 1 with as many as twenty, sixteen, ten, nine or fewer, e.g. one, two, three, four or five, amino acid additions, substitutions, deletions, and/or insertions within the disclosed set of H and/or L CDRs. Alternatively, an antigen binding site may comprise a set of H and/or L CDRs of the parent antibody or any of antibodies Table 1 with as many as twenty, sixteen, ten, nine or fewer, e.g.
one, two, three, four or five, amino acid substitutions within the disclosed set of H
and/or L CDRs.
Such modifications may potentially be made at any residue within the set of CDRs.

[042] In one embodiment, amino acid substitutions are those which: (1) reduce susceptibility to proteolysis, (2) reduce susceptibility to oxidation, (3) alter binding affinity for forming protein complexes, (4) alter binding affinities, and (4) confer or modify other physicochemical or functional properties of such analogs. Analogs can include various muteins of a sequence other than the naturally-occurring peptide sequence. For example, single or multiple amino acid substitutions (in one embodiment, SUBSTITUTE SHEET (RULE 26) conservative amino acid substitutions) may be made in the naturally-occurring sequence (in one embodiment, in the portion of the polypeptide outside the domain(s) forming intermolecular contacts. A conservative amino acid substitution should not substantially change the structural characteristics of the parent sequence (e.g., a replacement amino acid should not tend to break a helix that occurs in the parent sequence, or disrupt other types of secondary structure that characterizes the parent sequence). Examples of art-recognized polypeptide secondary and tertiary structures are described in Proteins, Structures and Molecular Principles (Creighton, Ed., W. H. Freeman and Company, New York (1984)); Introduction to Protein Structure (C. Branden and J. Tooze, eds., Garland Publishing, New York, N.Y. (1991)); and Thornton et at. Nature 354:105 (1991), which are each incorporated herein by reference.

[043] A further aspect is an antibody molecule comprising a VH domain that has at least about 60, 70, 80, 85, 90, 95, 98 or about 99 % amino acid sequence identity with a VH domain of any of antibodies listed in Table 1, the appended sequence listing or described herein, or with an HCDR (e.g., HCDR1, HCDR2, or HCDR3) shown in Table 8 or Table 29. The antibody molecule may optionally also comprise a VL domain that has at least 60, 70, 80, 85, 90, 95, 98 or 99 % amino acid sequence identity with a VL domain of any of the antibodies shown in Table 1, the appended sequence listing or described herein, or with an LCDR (e.g., LCDR1, LCDR2, or LCDR3) shown in Table 9 or Table 30. Algorithms that can be used to calculate % identity of two amino acid sequences comprise e.g. BLAST (Altschul et al., (1990) J. Mol. Biol. 215: 405-410), FASTA
(Pearson and Lipman (1988) PNAS USA 85: 2444-2448), or the Smith-Waterman algorithm (Smith and Waterman (1981) J. Mol Biol. 147: 195-197), e.g.
employing default parameters.

[044] Variants of the VH and VL domains and CDRs, including those for which amino acid sequences are set out herein, and which can be employed in targeting agents and antibodies for aVI36 can be obtained by means of methods of sequence alteration or mutation and screening for antigen targeting with desired characteristics.
Examples of desired characteristics include but are not limited to: increased binding affinity for antigen relative to known antibodies which are specific for the antigen;
increased neutralization of an antigen activity relative to known antibodies which are specific for the antigen if the activity is known; specified competitive ability with a known antibody or ligand to the antigen at a specific molar ratio; ability to SUBSTITUTE SHEET (RULE 26) immunoprecipitate complex; ability to bind to a specified epitope; linear epitope, e.g.
peptide sequence identified using peptide-binding scan as described herein, e.g. using peptides screened in linear and/or constrained conformation; conformational epitope, formed by non-continuous residues; ability to modulate a new biological activity of aVI36, or downstream molecule. Such methods are also provided herein.

[045] Variants of antibody molecules disclosed herein may be produced and used herein. Following the lead of computational chemistry in applying multivariate data analysis techniques to the structure/property-activity relationships (Wold, et al., Multivariate data analysis in chemistry. Chemometrics ¨Mathematics and Statistics in Chemistry (Ed.: B. Kowalski), D. Reidel Publishing Company, Dordrecht, Holland, 1984) quantitative activity-property relationships of antibodies can be derived using well-known mathematical techniques, such as statistical regression, pattern recognition and classification (Norman et al., Applied Regression Analysis. Wiley-Interscience; 3rd edition (April 1998); Kandel, Abraham & Backer, Eric. Computer-Assisted Reasoning in Cluster Analysis. Prentice Hall PTR, (May 11, 1995); Krzanowski, Wojtek.
Principles of Multivariate Analysis: A User's Perspective (Oxford Statistical Science Series, No 22 (Paper)). Oxford University Press; (December 2000); Witten, Ian H. & Frank, Eibe. Data Mining: Practical Machine Learning Tools and Techniques with Java Implementations.
Morgan Kaufmann; (October 11, 1999);Denison David G. T. (Editor), Christopher C.
Holmes, Bani K. Mallick, Adrian F. M. Smith. Bayesian Methods for Nonlinear Classification and Regression (Wiley Series in Probability and Statistics).
John Wiley &
Sons; (July 2002); Ghose, Arup K. & Viswanadhan, Vellarkad N. Combinatorial Library Design and Evaluation Principles, Software, Tools, and Applications in Drug Discovery).
The properties of antibodies can be derived from empirical and theoretical models (for example, analysis of likely contact residues or calculated physicochemical property) of antibody sequence, functional and three-dimensional structures and these properties can be considered singly and in combination.

[046] An antibody antigen-binding site composed of a VH domain and a VL
domain is typically formed by six loops of polypeptide: three from the light chain variable domain (VL) and three from the heavy chain variable domain (VH). Analysis of antibodies of known atomic structure has elucidated relationships between the sequence and three-dimensional structure of antibody combining sites. These relationships imply that, except for the third region (loop) in VH domains, binding site loops have one of a SUBSTITUTE SHEET (RULE 26) small number of main-chain conformations: canonical structures. The canonical structure formed in a particular loop has been shown to be determined by its size and the presence of certain residues at key sites in both the loop and in framework regions.

[047] This study of sequence-structure relationship can be used for prediction of those residues in an antibody of known sequence, but of an unknown three-dimensional structure, which are important in maintaining the three-dimensional structure of its CDR loops and hence maintain binding specificity. These predictions can be backed up by comparison of the predictions to the output from lead optimization experiments. In a structural approach, a model can be created of the antibody molecule using any freely available or commercial package, such as WAM. A protein visualisation and analysis software package, such as Insight II (Accelrys, Inc.) or Deep View may then be used to evaluate possible substitutions at each position in the CDR. This information may then be used to make substitutions likely to have a minimal or beneficial effect on activity.

[048] The techniques required to make substitutions within amino acid sequences of CDRs, antibody VH or VL domains and/or binding agents generally are available in the art. Variant sequences may be made, with substitutions that may or may not be predicted to have a minimal or beneficial effect on activity, and tested for ability to bind and/or neutralize and/or for any other desired property.

[049] Variable domain amino acid sequence variants of any of the VH and VL
domains whose sequences are specifically disclosed herein may be employed, as discussed.

[050] The term "polypeptide fragment" as used herein refers to a polypeptide that has an amino-terminal and/or carboxy-terminal deletion, but where the remaining amino acid sequence is identical to the corresponding positions in the naturally-occurring sequence deduced, for example, from a full-length cDNA sequence. Fragments typically are at least about 5, 6, 8 or 10 amino acids long, in one embodiment at least about 14 amino acids long, at least about 20 amino acids long, at least about 50 amino acids long, or at least about 70 amino acids long. The term "analog" as used herein refers to polypeptides which are comprised of a segment of at least about 25 amino acids that has substantial identity to a portion of a deduced amino acid sequence and which has at least one of the following properties: (1) specific binding to aVI36, under suitable binding conditions, (2) ability to block appropriate ligand/aVI36 binding, or (3) ability to inhibit aVI36 activity. Typically, polypeptide analogs comprise a conservative amino acid SUBSTITUTE SHEET (RULE 26) substitution (or addition or deletion) with respect to the naturally-occurring sequence.
Analogs typically are at least 20 amino acids long, at least 50 amino acids long or longer, and can often be as long as a full-length naturally-occurring polypeptide.

[051] Peptide analogs are commonly used in the pharmaceutical industry as non-peptide drugs with properties analogous to those of the template peptide.
These types of non-peptide compound are termed "peptide mimetics" or "peptidomimetics."
Fauchere, J. Adv. Drug Res. 15:29 (1986); Veber and Freidinger TINS p.392 (1985); and Evans et al., J. Med. Chem. 30:1229 (1987), which are incorporated herein by reference.
Such compounds are often developed with the aid of computerized molecular modeling.
Peptide mimetics that are structurally similar to therapeutically useful peptides may be used to produce an equivalent therapeutic or prophylactic effect. Generally, peptidomimetics are structurally similar to a paradigm polypeptide (i.e., a polypeptide that has a biochemical property or pharmacological activity), such as human antibody, but have one or more peptide linkages optionally replaced by a linkage chosen from:
--CH2NH--, --CH2S--, --CH2-CH2--, --CH=CH--(cis and trans), --COCH2--, --CH(OH)CH2--, and ¨CH2S0--, by methods well known in the art. Systematic substitution of one or more amino acids of a consensus sequence with a D-amino acid of the same type (e.g., D-lysine in place of L-lysine) may be used to generate more stable peptides. In addition, constrained peptides comprising a consensus sequence or a substantially identical consensus sequence variation may be generated by methods known in the art (Rizo and Gierasch Ann. Rev. Biochem. 61:387 (1992), incorporated herein by reference); for example, by adding internal cysteine residues capable of forming intramolecular disulfide bridges which cyclize the peptide.

[052] As used herein, the term "antibody" refers to a polypeptide or group of polypeptides that are comprised of at least one binding domain that is formed from the folding of polypeptide chains having three-dimensional binding spaces with internal surface shapes and charge distributions complementary to the features of an antigenic determinant of an antigen. An antibody typically has a tetrameric form, comprising two identical pairs of polypeptide chains, each pair having one "light" and one "heavy" chain.
The variable regions of each light/heavy chain pair form an antibody binding site.

[053] As used herein, a "targeted binding agent" is an agent, e.g.
antibody, or binding fragment thereof, that may bind to a target site. In one embodiment, the targeted binding agent is specific for only one target site. In other embodiments, the targeted SUBSTITUTE SHEET (RULE 26) binding agent is specific for more than one target site. In one embodiment, the targeted binding agent may be a monoclonal antibody and the target site may be an epitope. As described below, a targeted binding agent may comprise at least one antigen binding domain of an antibody, wherein said domain is fused or contained within a heterologous protein.

[054] "Binding fragments" of an antibody are produced by recombinant DNA
techniques, or by enzymatic or chemical cleavage of intact antibodies. Binding fragments include Fab, Fab', F(ab')2, Fv, and single-chain antibodies. An antibody other than a "bispecific" or "bifunctional" antibody is understood to have each of its binding sites identical. An antibody substantially inhibits adhesion of a receptor to a counter-receptor when an excess of antibody reduces the quantity of receptor bound to counter-receptor by at least about 20%, 40%, 60% or 80%, and more usually greater than about 85%
(as measured in an in vitro competitive binding assay).

[055] An antibody may be oligoclonal, a polyclonal antibody, a monoclonal antibody, a chimeric antibody, a CDR-grafted antibody, a multi-specific antibody, a bi-specific antibody, a catalytic antibody, a chimeric antibody, a humanized antibody, a fully human antibody, an anti-idiotypic antibody and antibodies that can be labeled in soluble or bound form as well as fragments, variants or derivatives thereof, either alone or in combination with other amino acid sequences provided by known techniques. An antibody may be from any species. The term antibody also includes binding fragments of the antibodies herein; exemplary fragments include Fv, Fab, Fab', single stranded antibody (svFC), dimeric variable region (Diabody) and disulphide stabilized variable region (dsFv).

[056] It has been shown that fragments of a whole antibody can perform the function of binding antigens. Examples of binding fragments are (Ward, E.S. et al., (1989) Nature 341, 544-546) the Fab fragment consisting of VL, VH, CL and CH1 domains; (McCafferty et al., (1990) Nature, 348, 552-554) the Fd fragment consisting of the VH and CH1 domains; (Holt et al., (2003) Trends in Biotechnology 21, 484-490) the Fv fragment consisting of the VL and VH domains of a single antibody; (iv) the dAb fragment (Ward, E.S. et al., Nature 341, 544-546 (1989), McCafferty et al., (1990) Nature, 348, 552-554, Holt et al., (2003) Trends in Biotechnology 21, 484-490], which consists of a VH or a VL domain; (v) isolated CDR regions; (vi) F(ab')2 fragments, a bivalent fragment comprising two linked Fab fragments (vii) single chain Fv molecules SUBSTITUTE SHEET (RULE 26) (scFv), wherein a VH domain and a VL domain are linked by a peptide linker which allows the two domains to associate to form an antigen binding site (Bird et al., (1988) Science, 242, 423-426õ Huston et al., (1988) PNAS USA, 85, 5879-5883); (viii) bispecific single chain Fv dimers (PCT/U592/09965) and (ix) "diabodies", multivalent or multispecific fragments constructed by gene fusion (W094/13804; Holliger, P.
(1993) et al., Proc. Natl. Acad. Sci. USA 90 6444-6448,). Fv, scFv or diabody molecules may be stabilized by the incorporation of disulphide bridges linking the VH and VL
domains (Reiter, Y. et al., Nature Biotech, 14, 1239-1245, 1996). Minibodies comprising a scFv joined to a CH3 domain may also be made (Hu, S. et al., (1996) Cancer Res., 56, 3055-3061). Other examples of binding fragments are Fab', which differs from Fab fragments by the addition of a few residues at the carboxyl terminus of the heavy chain domain, including one or more cysteines from the antibody hinge region, and Fab'-SH, which is a Fab' fragment in which the cysteine residue(s) of the constant domains bear a free thiol group.

[057] The term "epitope" includes any protein determinant capable of specific binding to an immunoglobulin or T-cell receptor. Epitopic determinants usually consist of chemically active surface groupings of molecules such as amino acids or sugar side chains and may, but not always, have specific three-dimensional structural characteristics, as well as specific charge characteristics. An antibody is said to specifically bind an antigen when the dissociation constant is .l_ 1AM, 100 nM, or 10 nM.

[058] The term "agent" is used herein to denote a chemical compound, a mixture of chemical compounds, a biological macromolecule, or an extract made from biological materials.

[059] "Active" or "activity" in regard to a aVI36 heterodimeric polypeptide refers to a portion of an aVI36 heterodimeric polypeptide that has a biological or an immunological activity of a native aVI36 polypeptide. "Biological" when used herein refers to a biological function that results from the activity of the native aVI36 polypeptide. A aVI36 biological activity includes, for example, aVI36 induced cell adhesion.

[060] "Mammal" when used herein refers to any animal that is considered a mammal. In one embodiment, the mammal is human.

[061] Digestion of antibodies with the enzyme, papain, results in two identical antigen-binding fragments, known also as "Fab" fragments, and a "Fc" fragment, having SUBSTITUTE SHEET (RULE 26) no antigen-binding activity but having the ability to crystallize. Digestion of antibodies with the enzyme, pepsin, results in the a F(ab')2 fragment in which the two arms of the antibody molecule remain linked and comprise two-antigen binding sites. The F(ab')2 fragment has the ability to crosslink antigen.

[062] "Fv" when used herein refers to the minimum fragment of an antibody that retains both antigen-recognition and antigen-binding sites.

[063] "Fab" when used herein refers to a fragment of an antibody that comprises the constant domain of the light chain and the CH1 domain of the heavy chain.

[064] The term "mAb" refers to monoclonal antibody.

[065] "Liposome" when used herein refers to a small vesicle that may be useful for delivery of drugs that may include the aVI36 polypeptide or antibodies to such an aVI36 polypeptide to a mammal.

[066] "Label" or "labeled" as used herein refers to the addition of a detectable moiety to a polypeptide, for example, a radiolabel, fluorescent label, enzymatic label chemiluminescent labeled or a biotinyl group. Radioisotopes or radionuclides may 14C, 15N, 35s, 90y, 99Tc, 1111n, 125L 131-%
include 3H, 1 fluorescent labels may include rhodamine, lanthanide phosphors or FITC and enzymatic labels may include horseradish peroxidase, I3-galactosidase, luciferase, alkaline phosphatase.

[067] Additional labels include, by way of illustration and not limitation:

enzymes, such as glucose-6-phosphate dehydrogenase ("G6PDH"), alpha-D-galactosidase, glucose oxydase, glucose amylase, carbonic anhydrase, acetylcholinesterase, lysozyme, malate dehydrogenase and peroxidase; dyes;
additional fluorescent labels or fluorescers include, such as fluorescein and its derivatives, fluorochrome, GFP (GFP for "Green Fluorescent Protein"), dansyl, umbelliferone, phycoerythrin, phycocyanin, allophycocyanin, o-phthaldehyde, and fluorescamine;
fluorophores such as lanthanide cryptates and chelates e.g. Europium etc (Perkin Elmer and Cis Biointernational); chemoluminescent labels or chemiluminescers, such as isoluminol, luminol and the dioxetanes; sensitizers; coenzymes; enzyme substrates;
particles, such as latex or carbon particles; metal sol; crystallite;
liposomes; cells, etc., which may be further labelled with a dye, catalyst or other detectable group;
molecules such as biotin, digoxygenin or 5-bromodeoxyuridine; toxin moieties, such as for example a toxin moiety selected from a group of Pseudomonas exotoxin (PE or a cytotoxic fragment or mutant thereof), Diptheria toxin or a cytotoxic fragment or mutant thereof, a SUBSTITUTE SHEET (RULE 26) botulinum toxin A, B, C, D, E or F, ricin or a cytotoxic fragment thereof e.g.
ricin A, abrin or a cytotoxic fragment thereof, saporin or a cytotoxic fragment thereof, pokeweed antiviral toxin or a cytotoxic fragment thereof and bryodin 1 or a cytotoxic fragment thereof.

[068] The term "pharmaceutical agent or drug" as used herein refers to a chemical compound or composition capable of inducing a desired therapeutic effect when properly administered to a patient. Other chemistry terms herein are used according to conventional usage in the art, as exemplified by The McGraw-Hill Dictionary of Chemical Terms (Parker, S., Ed., McGraw-Hill, San Francisco (1985)), (incorporated herein by reference).

[069] As used herein, "substantially pure" means an object species is the predominant species present (i.e., on a molar basis it is more abundant than any other individual species in the composition), and a substantially purified fraction may be a composition wherein the object species comprises at least about 50 percent (on a molar basis) of all macromolecular species present. Generally, a substantially pure composition will comprise more than about 80 percent of all macromolecular species present in the composition, or may comprise at least about 85%, 90%, 95%, and 99%. In one aspect, the object species is purified to essential homogeneity (contaminant species cannot be detected in the composition by conventional detection methods) wherein the composition consists essentially of a single macromolecular species.

[070] The term "patient" includes human and veterinary subjects.
II. Methods of Treatment A. Overview of Treatment Methods for aVI36 Overexpressing Cancer Cells

[071] Understanding the role of aVI36 in certain cancers, aVI36 may be inhibited by administering an aVI36 targeted binding agent to a patient or to cancer cells may be used to treat cancer or inhibit growth of tumor cells, including, but not limited to, cancer cells overexpres sing aVI36.

[072] An aVI36 targeted binding agent that specifically binds to aVI36and inhibits binding of ligands to aVI36 may be used in a method of treating a malignant tumor in an animal, including, but not limited to, breast cancer.
Alternatively, the malignant tumor may be ovarian cancer, pancreatic cancer, lung cancer, colorectal cancer, SUBSTITUTE SHEET (RULE 26) head and neck cancer, oesophageal cancer, gastric cancer, and hepatocellular cancer. In another embodiment, the aVI36 targeted binding agent may be used to inhibit growth of tumor cells, including, but not limited to, tumor cells from the types of cancer recited in this paragraph.

[073] In one embodiment, the animal may be a mammal. In another embodiment, the animal may be a human.

[074] In such a treatment, one or more aVI36 targeted binding agents may be used. Thus, the use of singular "a" includes the plural.

[075] Such methods may be used in isolation or they may be used in combination with a diagnosis that the malignant tumor or the tumor cells overexpress aVI36.

[076] In one embodiment, such methods employ the aVI36 targeted binding agents described in Section IV within the dosage range described. In one embodiment, the aVI36 targeted binding agent is a monoclonal antibody. In another embodiment, it is a fully human monoclonal embodiment. In yet another embodiment, it is sc 264RAD.

[077] In one embodiment, the level of at least one downstream target of aVI36 downregulated. In one embodiment, the level of at least one of Akt2 and Smad2 is downregulated. In one embodiment, the total level of the target is downregulated. In another embodiment, the phospho level of the target is downregulated.
Downregulation may be measured by determining the level of a protein or downregulation may be measured by determining the level of an mRNA. Downregulation and/or inhibition includes a reduction of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100% compared to before treatment.

[078] In one embodiment, the breast cancer cells are resistant to trastuzumab.
Thus, one embodiment includes a method of suppressing growth of trastuzumab-resistant tumor cells comprising administering to said cells a therapeutically effective dose of an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36.
B. Combination Therapy

[079] When aVI36 inhibitors are used to treat a malignant tumor or to inhibit growth of tumor cells, the aVI36 targeted binding agent may be administered as a sole therapy or it may be administered in a combination therapy regime, with conventional SUBSTITUTE SHEET (RULE 26)

80 PCT/EP2014/071028 surgery or radiotherapy or chemotherapy. Such conjoint treatment may be achieved by way of the simultaneous, sequential, or separate dosing of the individual components of the treatment. Where the administration is sequential or separate, the delay in administering the second component should not be such as to lose the beneficial effect of the combination.
[080] One or more combination therapy agents may be used in addition to a aVI36 targeted binding agent; likewise, one or more aVI36 targeted binding agents may be used. Thus, the use of singular "a" includes the plural. Such combination products employ a aVI36 targeted binding agent described herein within the dosage range described and the combination therapy agent within its approved dosage range.
1. Combination Therapy for Breast Cancer

[081] Combination therapy may be employed in the treatment of a breast cancer tumor or to inhibit growth of breast cancer tumor cells.

[082] Such methods may be used in isolation or they may be used in combination with a diagnosis that the malignant tumor or the tumor cells overexpress aVI36, overexpress HER2, or overexpress aVI36 and HER2.

[083] Such methods may be used in isolation or they may be used in combination with a diagnosis that the malignant tumor or the tumor cells overexpress aVI36.

[084] In one embodiment, the breast cancer cells are resistant to trastuzumab.
Thus, one embodiment includes a method of suppressing growth of trastuzumab-resistant tumor cells comprising administering to said cells a therapeutically effective dose of an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36 and a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

[085] In one embodiment, the combination therapy agent may be trastuzumab.
In another embodiment, the combination therapy agent is a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

[086] In another embodiment, the combination therapy agent may be gemcitabine, docetaxel, EGFR inhibitor, HER-2 inhibitor (including but not limited to trastuzumab or Herceptin ), PI3K inhibitor (ATK inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus), AZD2014, PI3Ka inhibitor, PI3K13 inhibitor SUBSTITUTE SHEET (RULE 26) (AZD8186, GSK2636771, SAR 260301), Pan PI3K inhibitor (GDC0941, GDC0942)), MEK/RAF inhibitor (such as vemurafanib (RAF inhibitor), seluemetinib (MEK
inhibitor), trametinib (MEK inhibitor)), PD-1 inhibitor, PDL1 inhibitor, or inhibitor.

[087] In one embodiment, the level of at least one downstream target of aVI36 and/or HER2 is downregulated. In one embodiment, the level of at least one of Akt2 and Smad2 is downregulated. In one embodiment, the total level of the target is downregulated. In another embodiment, the phospho level of the target is downregulated.
Downregulation may be measured by determining the level of a protein or downregulation may be measured by determining the level of an mRNA.
Downregulation includes a reduction of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100% compared to before treatment.
2. Combination Therapy for Ovarian Cancer

[088] Combination therapy may be employed in the treatment of an ovarian cancer tumor or to inhibit growth of ovarian cancer tumor cells.

[089] Such methods may be used in isolation or they may be used in combination with a diagnosis that the malignant tumor or the tumor cells overexpress aVI36, overexpress HER2, or overexpress aVI36 and HER2.

[090] Such methods may be used in isolation or they may be used in combination with a diagnosis that the malignant tumor or the tumor cells overexpress aVI36.

[091] In one embodiment, the ovarian cancer cells are resistant to trastuzumab.
Thus, one embodiment includes a method of suppressing growth of trastuzumab-resistant tumor cells comprising administering to said cells a therapeutically effective dose of an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36 and a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

[092] In one embodiment, the combination therapy agent may be trastuzumab.

[093] In another embodiment, the combination therapy agent may be gemcitabine, docetaxel, EGFR inhibitor, HER-2 inhibitor (including but not limited to trastuzumab or Herceptin ), PI3K inhibitor (ATK inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus), AZD2014, PI3Ka inhibitor, PI3KI3 inhibitor SUBSTITUTE SHEET (RULE 26) (AZD8186, GSK2636771, SAR 260301), Pan PI3K inhibitor (GDC0941, GDC0942)), MEK/RAF inhibitor (such as vemurafanib (RAF inhibitor), seluemetinib (MEK
inhibitor), trametinib (MEK inhibitor)), PD-1 inhibitor, PDL1 inhibitor, or inhibitor.
3. Combination Therapy for Pancreatic Cancer

[094] Combination therapy may be employed in the treatment of a pancreatic cancer tumor or to inhibit growth of pancreatic cancer cells.

[095] In one embodiment, the combination therapy agent may be gemcitabine, abraxane, folfirinox (a combination therapy approach using 5-fluorouracil, oxaliplatin, irinotecan, and leucovorin), EGFR inhibitor, HER-2 inhibitor (including but not limited to trastuzumab or Herceptin ), PI3K inhibitor (ATK inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus), AZD2014, PI3Ka inhibitor, PI3KI3 inhibitor (AZD8186, GSK2636771, SAR 260301), Pan PI3K inhibitor (GDC0941, GDC0942)), MEK/RAF inhibitor (such as vemurafanib (RAF inhibitor), seluemetinib (MEK
inhibitor), trametinib (MEK inhibitor)), PD-1 inhibitor, PDL1 inhibitor, or inhibitor.
4. Combination Therapy for Lung Cancer

[096] Combination therapy may be employed in the treatment of a lung cancer tumor or to inhibit growth of lung cancer cells. In one embodiment, the cancer may be adenocarcinoma, squamous cell carcinoma, or small cell lung cancer.

[097] In one embodiment, the combination therapy agent may be gefitinib (Iressal0), AZD9291, erlotinib (Tarceva ), platinum-based cytotoxics, docetaxel, PI3K
inhibitor (ATK inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus), AZD2014, PI3Ka inhibitor, PI3KI3 inhibitor (AZD8186, GSK2636771, SAR 260301), Pan PI3K inhibitor (GDC0941, GDC0942)), MEK/RAF inhibitor (such as vemurafanib (RAF inhibitor), seluemetinib (MEK inhibitor), trametinib (MEK inhibitor)), PD-inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.
5. Combination Therapy for Colorectal Cancer

[098] Combination therapy may be employed in the treatment of a colorectal cancer tumor or to inhibit growth of colorectal cancer cells.

SUBSTITUTE SHEET (RULE 26)

[099] In one embodiment, the combination therapy agent may be gemcitabine, folfirinox, docetaxel, platinum-based triplets, 5-fluorouracil, cetuximab (Erbitux10), rapalogue (such as everolimus), ATK inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus), AZD2014, PI3Ka inhibitor, PI3KI3 inhibitor (AZD8186, GSK2636771, SAR 260301), Pan PI3K inhibitor (GDC0941, GDC0942)), MEK/RAF
inhibitor (such as vemurafanib (RAF inhibitor), seluemetinib (MEK inhibitor), trametinib (MEK inhibitor)), PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor..
6. Combination Therapy for Head and Neck Cancer

[0100] Combination therapy may be employed in the treatment of head and neck cancer or to inhibit growth of head and neck cancer cells.

[0101] In one embodiment, the combination therapy agent may be gemcitabine, platinum-based cytotoxics, docetaxel, radiation, cetuximab (Erbitux10), PI3K
inhibitor (ATK inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus ATK
inhibitor (such as AZD5363, MK2206), rapalogue (such as everolimus), AZD2014, PI3Ka inhibitor, PI3KI3 inhibitor (AZD8186, GSK2636771, SAR 260301), Pan PI3K
inhibitor (GDC0941, GDC0942)), MEK/RAF inhibitor (such as vemurafanib (RAF
inhibitor), seluemetinib (MEK inhibitor), trametinib (MEK inhibitor)), PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.
7. Combination Therapy for Oesophageal Cancer

[0102] Combination therapy may be employed in the treatment of oesophageal cancer or to inhibit growth of oesophageal cancer cells.

[0103] In one embodiment, the combination therapy agent may be radiation or standard chemotherapeutics, which are further elaborated in section II.B.10, below.
8. Combination Therapy for Gastric Cancer

[0104] Combination therapy may be employed in the treatment of gastric cancer or to inhibit growth of gastric cancer cells.

[0105] In one embodiment, the combination therapy agent may be triplet chemotherapy (paclitaxel, cisplatin, and S-1).
9. Combination Therapy for Hepatocellular Cancer

[0106] Combination therapy may be employed in the treatment of hepatocellular cancer or to inhibit growth of hepatocellular cancer cells.

SUBSTITUTE SHEET (RULE 26)

[0107] In one embodiment, the combination therapy agent may be sorafanib or TACE (TNFa convertase enzyme) inhibitor.
10. Combination Therapy Generally

[0108] The anti-tumor treatment defined herein may be applied as a sole therapy or may involve, in addition to the compounds herein, conventional surgery or radiotherapy or chemotherapy.

[0109] The compounds may be used in the methods herein as either a single agent by itself or in combination with other clinically relevant agents or techniques. For example, the anti-cancer treatment defined herein may be applied as a sole therapy or may involve, in addition to the compounds herein, conventional surgery or radiotherapy or chemotherapy. Such radiotherapy may include one or more of the following categories of radiation:
(i) external radiation therapy using electromagnetic radiation, and intraoperative radiation therapy using electromagnetic radiation;
(ii) internal radiation therapy or brachytherapy; including interstitial radiation therapy or intraluminal radiation therapy; or (iii) systemic radiation therapy, including but not limited to iodine 131 and strontium 89;

[0110] Such chemotherapy may include one or more of the following categories of anti-tumor agents:

[0111] Antiproliferative/antineoplastic drugs and combinations thereof, as used in medical oncology, such as DNA alkylating agents (for example cisplatin, oxaliplatin, carboplatin, cyclophosphamide, nitrogen mustard, melphalan, chlorambucil, busulphan, temozolamide and nitrosoureas); antimetabolites (for example gemcitabine, fludarabine, capecitabine and antifolates such as fluoropyrimidines like 5-fluorouracil and pemetrexed, tegafur, raltitrexed, methotrexate, cytosine arabinoside, and hydroxyurea);
antitumour antibiotics (for example anthracyclines like adriamycin, bleomycin, doxorubicin, liposomal doxorubicin, daunomycin, epirubicin, idarubicin, mitomycin-C, dactinomycin and mithramycin); and topoisomerase inhibitors (for example epipodophyllotoxins like etoposide and teniposide, amsacrine, topotecan, camptothecin and irinotecan); inhibitors of DNA repair mechanisms such as CHK kinase; DNA-dependent protein kinase inhibitors; inhibitors of poly (ADP-ribose) polymerase (PARP
SUBSTITUTE SHEET (RULE 26) inhibitors, including for example Olaparib); and Hsp90 inhibitors such as tanespimycin and retaspimycin;

[0112] Compounds that inhibit progression through the cell cycle such as antimitotic agents (for example vinca alkaloids like vincristine, vinblastine, vindesine and vinorelbine; epothilones such as ixabepilone and patupilone; taxoids like taxol and docetaxel; polo-like kinase inhibitors; and inhibitors of kinesin motor proteins such as Eg5 protein inhibitors); aurora kinase inhibitors (for example AZD1152, PH739358, VX-680, MLN8054, R763, MP235, MP529, VX-528 AND AX39459); cyclin dependent kinase inhibitors such as CDK2 and/or CDK4 inhibitors; and inhibitors of centromeric protein function such as CENP-E inhibitors;

[0113] Cytostatic agents that alter hormone-dependent growth such as antiestrogens (for example tamoxifen, fulvestrant, toremifene, raloxifene, droloxifene and iodoxyfene), antiandrogens (for example enzalutamide, bicalutamide, flutamide, nilutamide and cyproterone acetate); LHRH antagonists or LHRH agonists (for example goserelin, leuprorelide and buserelin); progestogens (for example megestrol acetate);
aromatase inhibitors (for example as anastrozole, letrozole, vorazole and exemestane);
and inhibitors of 5cc-reductase such as finasteride; CYP17A1 inhibitors such as abiraterone acetate;

[0114] Anti-invasion agents such as c-Src kinase family inhibitors like AZD0530, dasatinib or BMS-354825; bosutinib (SKI-606), metalloproteinase inhibitors like marimastat; inhibitors of urokinase plasminogen activator receptor function;
antibodies to heparanase, inhibitors of FAK or focal-adhesion kinase; small molecule inhibitors of MET receptor kinase (for example volitinib); antibodies to MET
receptor kinase or the MET ligand hepatocyte growth factor (for example onartuzumab);

[0115] Inhibitors of tumor, tumor stem cell, and endothelial cell precursor migration, including chemokines and chemokine receptors, such as SDF1, MCP-1, CXCR2 and CXCR4;

[0116] Inhibitors of growth factor signaling: for example such inhibitors include growth factor antibodies and growth factor receptor antibodies (for example the anti-erbB2 antibody trastuzumab [HerceptinTm], the anti-EGFR antibodies panitumumab and cetuximab [Erbitux, C225] and any growth factor or growth factor receptor antibodies disclosed by Stern et al. Critical reviews in oncology/haematology, 2005, Vol.
54, pp11-29); such inhibitors also include tyrosine kinase inhibitors, for example SUBSTITUTE SHEET (RULE 26) inhibitors of the epidermal growth factor family and their receptors (for example EGFR
family tyrosine kinase inhibitors such as gefitinib, i.e., ZD1839, erlotinib, i.e., OSI-774, and CI 1033; combined EGFR and erbB2 tyrosine kinase inhibitors such as lapatinib;
mixed erbB 1/2 inhibitors such as afatanib; and irreversible inhibitors of EGFR and Her2 such as HKI-272, irreversible inhibitors of EGFR such as AZD9291; inhibitors of the hepatocyte growth factor family and their receptors; inhibitors of the insulin growth factor family including small molecule kinase inhibitors and antibodies directed to insulin-like growth factors and insulin-like growth factor receptors; inhibitors of the platelet-derived growth factor family and their receptors such as imatinib and/or nilotinib (AMN107); c-kit inhibitors, AnLK inhibitors, F1t3 kinase inhibitors, c-abl kinase inhibitors, and inhibitors of CSF-1R or TRK kinase;

[0117] Inhibitors of signal transduction kinases such as FGFR (for example AZD4547), PIM (for example AZD1208), MEK (for example Selumetinib (AZD6244), AKT (for example AZD5363), inhibitors of TOR kinases (including TORC1 and TORC2, for example AZD2014), and inhibitors of PI3 kinase, including isoforms such as PI3K-a, PI3K-I3 or PI3K-6 (for example AZD8186); inhibitors of serine/threonine kinases such as Ras or Raf kinases (for example sorafenib or vemurafenib); Inhibitors of PDK, SGK, PI4K or PIP5K, JAK, STAT (including STAT3, an inhibitor of which is AZD9150) and IRAK4; ATR inhibitors (for example AZD6738) or ATM inhibitors; ABL inhibitors such as imatinib or nilotinib, BTK inhibitors such as ibrutinib, SYK inhibitors such as fostamatinib, and cyclin dependent kinase inhibitors; farnesyl transferase inhibitors such as tipifarnib (R115777) and lonafarnib (5CH66336));

[0118] Antiangiogenic agents such as those that inhibit the effects of vascular endothelial growth factor [for example the anti-vascular endothelial cell growth factor antibody bevacizumab (AvastinTM) and for example, a VEGF receptor tyrosine kinase inhibitor such as vandetanib (ZD6474), sorafenib, vatalanib (PTK787), sunitinib (5U11248), axitinib (AG-013736), pazopanib (GW 786034) and cediranib (AZD2171);
compounds such as those disclosed in International Patent Applications W097/22596, WO 97/30035, WO 97/32856 and WO 98/13354; and compounds that work by other mechanisms (for example linomide, inhibitors of integrin ccv133 function and angiostatin)], or inhibitors of angiopoietins and their receptors (Tie-1 and Tie-2), inhibitors of PLGF, inhibitors of delta-like ligand (DLL-4);

SUBSTITUTE SHEET (RULE 26)

[0119] Vascular damaging agents such as Combretastatin A4 and compounds disclosed in International Patent Applications WO 99/02166, WO 00/40529, WO 00/41669, WO 01/92224, WO 02/04434 and WO 02/08213;

[0120] An endothelin receptor antagonist, for example zibotentan (ZD4054) or atrasentan;

[0121] Antisense therapies, for example those that are directed to the targets listed above, such as ISIS 2503, an anti-ras antisense, an oblimerson sodium, an anti-2 antisense, or antisense to XIAP such as AEG35156;

[0122] Gene therapy approaches, including for example approaches to replace aberrant genes such as aberrant p53 or aberrant BRCA1 or BRCA2, GDEPT
(gene-directed enzyme pro-drug therapy); approaches such as those using cytosine deaminase, thymidine kinase or a bacterial nitroreductase enzyme; and approaches to increase patient tolerance to chemotherapy or radiotherapy, such as multi-drug resistance gene therapy;

[0123] Immunotherapy approaches, including for example ex-vivo and in-vivo approaches to increase the immunogenicity of patient tumor cells, such as transfection with cytokines such as interleukin 2, interleukin 4 or granulocyte-macrophage colony stimulating factor; approaches to decrease T-cell anergy or regulatory T-cell function;
approaches that enhance T-cell responses to tumors, such as blocking antibodies to CTLA4 (for example ipilimumab and tremelimumab), B7H1, PD-1 (for example BMS-936558), and agonist antibodies to CD137; approaches using transfected immune cells such as cytokine-transfected dendritic cells; approaches using cytokine-transfected tumor cell lines, approaches using antibodies to tumor associated antigens, and antibodies that deplete target cell types (e.g., unconjugated anti-CD20 antibodies such as Rituximab, radiolabeled anti-CD20 antibodies Bexxar and Zevalin, and anti-CD54 antibody Campath); approaches using anti-idiotypic antibodies; approaches that enhance Natural Killer cell function; and approaches that utilize antibody-toxin conjugates (e.g. anti-CD33 antibody Mylotarg); immunotoxins such as moxetumumab pasudotox; agonists of toll-like receptor 7 or toll-like receptor 9;

[0124] Apoptosis-inducing approaches, including antibodies to death receptor 4 or death receptor 5 or cross reactive antibodies binding to both death receptor 4 and death receptor 5; and inhibitors of XIAP and cIAP1 and cIAP2; antibodies to FAS;

SUBSTITUTE SHEET (RULE 26)

[0125] Cytokine treatment, including tumor necrosis factor alpha, and recombinant Trail protein, and small molecule or protein mimetics of the Trail protein;
FAS or Tweak ligands, or mimetics of these ligands;

[0126] Inhibitors of proteasome mediated protein degradation including but not limited to proteasome inhibitors such as VelcadeTm , inhibitors of ubiquitin ligases, inhibitors of ubiquitin proteases, inhibitors of protein Neddylation, and inhibitors of protein sumoylation; or

[0127] Efficacy enhancers, such as leucovorin.

[0128] According to a further embodiment, there is provided a kit comprising a avI36 binding agent in combination with an anti-tumor agent chosen from the listing above. In certain embodiments, the kit additionally comprises instructions for the use of said compound(s) in the treatment of cancer or inhibiting the growth of tumor cells.

[0129] According to a further embodiment, there is provided a kit comprising:
a) an aVI36 targeted binding agent in a first unit dosage form;
b) an anti-tumor agent chosen from the list above in a second unit dosage form;
and c) container means for containing said first and second dosage forms.
III. Diagnostic Methods

[0130] In one embodiment, a method of diagnosing breast cancer sensitive to aVI36 and HER2 inhibition in a patient comprises analyzing a patient sample for the presence or absence of tumor cells overexpressing aVI36 and HER2 by measuring the expression levels of aVI36 and HER2, wherein the patient is diagnosed with breast cancer sensitive to aVI36 and HER2 inhibition if aVI36 and HER2 are both overexpressed. By sensitive to inhibition, this includes improvement of at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 95%, 99%, or 100% in any parameter of tumor or cancer cell progression, including but not limited to reduction in tumor growth, tumor size, tumor aggression, or tumor invasion, in either patients and/or laboratory experiments, and/or extended survival in either patients and/or laboratory models; and/or reduction in signaling from downstream molecular messengers.

[0131] In another embodiment, a method for diagnosing and treating cancer sensitive to aVI36 inhibition in a patient comprises analyzing a patient sample for the presence or absence of cancer cells overexpressing aVI36 by measuring the levels of SUBSTITUTE SHEET (RULE 26) aVI36, wherein the patient is diagnosed with cancer sensitive to aVI36 inhibition if aVI36 is overexpressed, and administering to the diagnosed patient a therapeutically effective dose of an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36.

[0132] In one aspect, the method also comprises measuring the levels of HER2, wherein the patient is diagnosed with a cancer sensitive to HER2 inhibition if HER2 is overexpressed.

[0133] In another embodiment, a method for diagnosing and treating breast cancer sensitive to HER2 inhibition in a patient comprises analyzing a patient sample for the presence or absence of breast cancer cells overexpressing aVI36 and HER2 by measuring the levels of the aVI36 and HER2, wherein the patient is diagnosed with breast cancer sensitive to aVI36 and HER2 inhibition if both aVI36 and HER2 are overexpressed, and administering to the diagnosed patient a therapeutically effective dose of a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

[0134] Another embodiment includes a method for diagnosing and treating breast cancer sensitive to aVI36 and HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of breast cancer cells overexpressing aVI36 and HER2 by measuring the levels of the aVI36 and HER2, wherein the patient is diagnosed with breast cancer sensitive to aVI36 and HER2 inhibition if both aVI36 and HER2 are overexpressed, and administering to the diagnosed patient a therapeutically effective dose of an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36 and a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

[0135] An embodiment yet further includes method for treating cancer sensitive to aVI36 inhibition in a patient sample comprising requesting a test to determine whether a patient sample contains cancer cells overexpressing aVI36, and administering a therapeutically effective dose of an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36 if the patient sample contains cancer cells overexpres sing aVI36.

[0136] One embodiment includes a method for treating breast cancer sensitive to aVI36 and HER2 inhibition in a patient sample comprising requesting a test to determine SUBSTITUTE SHEET (RULE 26) whether a patient sample contains cancer cells overexpressing aVI36 and HER2, and administering a therapeutically effective dose of:
a. an aVI36 targeted binding agent that specifically binds to aVI36 and inhibits binding of ligands to aVI36; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2 if the patient sample contains cancer cells overexpressing aVI36 and HER2.

[0137] In one embodiment, the expression levels are measured by measuring protein expression. In one method, aVI36 and/or HER2 are detected by the extent of tumor cell staining and/or the intensity of tumor cell staining. In one embodiment, aVI36 and/or HER2 are detected by the extent of tumor cells staining using a scoring system where 0=0%, 1=<25%, 2=25-50%, 3=>50%-75%, and 4=>75%. In another embodiment, aVI36 and/or HER2 are detected by an intensity of tumor cell staining score of 0=negative, 1=weak, 2=moderate, 3=strong. In one embodiment, the aVI36 is quantified as overexpressed if it has a final score of >5 when the score of extent of tumor cell staining and the score of intensity of staining in a scoring are added together. In another embodiment, the HER2 is quantified as overexpressed if it has a final score of >5 when the score of extent of tumor cell staining and the score of intensity of staining in a scoring are added together. In one embodiment, each sample is scored by more than one pathologist and the scores are averaged.

[0138] In one method, tumors may be classified for aVI36 positivity by IHC
samples were stained for aVI36, and then using an independent pathologist scoring system tumor classified on a 0-7 staining intensity scale (which is a composite of 0-4 percentage positivity, and then 0-3 for percentage intensity). From this scale scores of 5, 6, 7 were deemed strongly avb6 positive (approximately 15.1% and 16% of total samples across 2 cohorts of tumors). this was performed using two independent pathologists.
Tumors over-expressing avb6 integrin can be determined using a scaled pathologies scoring system incorporating both intensity and percentage cell positivity. The scoring system would be transferred from sample set to sample set using reference samples representative of each scoring intensity relative to an internal control. Alternatively automated imaging techniques can be used using reference samples to set thresholds. These platforms commonly include colour deconvolution algorithms, positive pixel counts, combined with SUBSTITUTE SHEET (RULE 26) pattern recognition software. Examples of such platforms include Aperio Genie(m4) and Definiens(m4) automated image quantification packages.

[0139] In another embodiment, the expression levels are measured by measuring mRNA expression. For example, aVI36 expression levels are measured by measuring mRNA expression of ITGB6, which is the gene for the 136 subunit. Numerous techniques such as qRT-PCR, Fluidigm, Nanostring, RNAseq (e.g. IIlumina), Affymetrix gene profiling may be used by the person skilled in the art using their common general knowledge to measure the RNA levels and these may be calibrated against the IHC
analysis to establish suitable scoring levels.

[0140] A method for diagnosing cancer sensitive to aVI36 inhibition in a patient that can be treated by inhibiting aVI36 comprising:
a. obtaining a biological sample from the subject;
b. applying an aVI36 targeted binding agent that specifically binds to aVI36 to the sample, wherein the presence of aVI36 creates a aVI36 targeted binding agent-aVI36 complex;
c. diagnosing an aggressive form of breast cancer where the complex of step b) is detected at a level indicating aVI36 overexpression.

[0141] A method for diagnosing breast cancer sensitive to aVI36 and HER2 inhibition in a patient that can be treated by inhibiting aVI36 and HER2 comprising:
a. obtaining a biological sample from the subject;
b. applying an aVI36 targeted binding agent that specifically binds to aVI36 to the sample, wherein the presence of aVI36 creates a aVI36 targeted binding agent-aVI36 complex;
c. optionally applying a HER2 targeted binding agent that specifically binds to HER2 to the sample, wherein the presence of HER2 creates a HER2 binding agent-HER2 complex; and d. diagnosing an aggressive form of breast cancer where the complexes of steps b) and c) are detected at a level indicating aVI36 and HER2 overexpression.

[0142] A complex of aVI36 targeted binding agent and aVI36 or a complex of a HER2 targeted binding agent and HER2 may be detected by methods well known in the art. In one embodiment, the extent of tumor cell staining and/or the intensity of tumor cell staining may be used, as described above. In another embodiment, if the targeted binding SUBSTITUTE SHEET (RULE 26) agent is an antibody, an ELISA assay may be used to measure overexpression.
Alternatively, an immunohistochemical analysis may be used. Alternatively, FMAT
macroconfocal scanning may be used to detect the complex.
IV. Further Description of 0[136 Targeted Binding Agent

[0143] Embodiments relate to targeted binding agents that bind to aV136 integrin (aV136). In some embodiments, the binding agents bind to aV136 and inhibit the binding of ligands to aVI36. In one embodiment, the targeted binding agents are monoclonal antibodies, or binding fragments thereof. In another embodiment, the antibodies bind only to the P6 chain yet are able to inhibit binding of ligands to aVI36.

[0144] Other embodiments include fully human anti-aV136 antibodies, and antibody preparations that are therapeutically useful. In one embodiment, the anti-aV136 antibody preparations have desirable therapeutic properties, including strong binding affinity for aVI36, and the ability to inhibit TGFPLAP mediated cell adhesion in vitro.

[0145] Embodiments also include fully human isolated binding fragments of anti-aV136 antibodies. In one embodiment the binding fragments are derived from fully human anti-aV136 antibodies. Exemplary fragments include Fv, Fab' or other well-known antibody fragments, as described in more detail below. Embodiments also include cells that express fully human antibodies against aVI36. Examples of cells include hybridomas, or recombinantly created cells, such as Chinese hamster ovary (CHO) cells, variants of CHO cells (for example DG44) and NSO cells that produce antibodies against aVI36.
Additional information about variants of CHO cells can be found in Andersen and Reilly (2004) Current Opinion in Biotechnology 15, 456-462 which is incorporated herein in its entirety by reference.

[0146] In addition, embodiments include methods of using these antibodies for treating an aV136-related disease or disorder. An aV136-related disease or disorder can be any condition arising due to the aberrant activation or expression of aVI36.
Examples of such diseases include where aV136 aberrantly interacts with its ligands thereby altering cell-adhesion or cell signaling properties. This alteration in cell adhesion or cell signaling properties can result in neoplastic diseases. Other aV136-related diseases or disorders include inflammatory disorders, lung disease, diseases associated with fibrosis and any disease associated with dysregulated TGF-P.

SUBSTITUTE SHEET (RULE 26)

[0147] In one example, the aVP6-related disease is a neoplastic disease such as melanoma, small cell lung cancer, non-small cell lung cancer, glioma, hepatocellular (liver) carcinoma, thyroid tumor, gastric (stomach) cancer, prostate cancer, breast cancer, ovarian cancer, bladder cancer, lung cancer, glioblastoma, endometrial cancer, kidney cancer, colon cancer, pancreatic cancer, oesophageal carcinoma, head and neck cancers, mesothelioma, sarcomas, biliary (cholangiocarcinoma), small bowel adenocarcinoma, pediatric malignancies and epidermoid carcinoma.

[0148] In another example, the aVP6-related disease is an inflammatory disorder such as inflammatory bowel disease; systemic lupus erythematosus; rheumatoid arthritis;
juvenile chronic arthritis; spondyloarthropathies; systemic sclerosis, for example, scleroderma; idiopathic inflammatory myopathies for example, dermatomyositis, polymyositis; Sjogren's syndrome; systemic vaculitis; sarcoidosis;
thyroiditis, for example, Grave's disease, Hashimoto's thyroiditis, juvenile lymphocytic thyroiditis, atrophic thyroiditis; immune-mediated renal disease, for example, glomerulonephritis, tubulointerstitial nephritis; demyelinating diseases of the central and peripheral nervous systems such as multiple sclerosis, idiopathic polyneuropathy; hepatobiliary diseases such as infectious hepatitis such as hepatitis A, B, C, D, E and other nonhepatotropic viruses;
autoimmune chronic active hepatitis; primary biliary cirrhosis; granulomatous hepatitis;
and sclerosing cholangitis; inflammatory and fibrotic lung diseases (e.g., cystic fibrosis);
gluten-sensitive enteropathy; autoimmune or immune-mediated skin diseases including bullous skin diseases, erythema multiforme and contact dermatitis, psoriasis;
allergic diseases of the lung such as eosinophilic pneumonia, idiopathic pulmonary fibrosis, allergic conjunctivitis and hypersensitivity pneumonitis, transplantation associated diseases including graft rejection and graft-versus host disease.

[0149] In yet another example, the aVP6-related disease is fibrosis such as kidney or lung fibrosis.

[0150] In yet another example, the aVP6-related disease is associated with dysregulated TGF-P include cancer and connective tissue (fibrotic) disorders.

[0151] Other embodiments include diagnostic assays for specifically determining the quantity of aVP6 in a biological sample. The assay kit can include anti-aVP6 antibodies along with the labels for detecting such antibodies. These diagnostic assays are useful to screen for aV related diseases or P6 disorders including, but not limited to, neoplastic diseases, such as, melanoma, small cell lung cancer, non-small cell SUBSTITUTE SHEET (RULE 26) lung cancer, glioma, hepatocellular (liver) carcinoma, glioblastoma, and carcinoma of the thyroid, stomach, prostate, breast, ovary, bladder, lung, uterus, kidney, colon, and pancreas, salivary gland, and colorectum.

[0152] Another aspect is an antagonist of the biological activity of aVP6 wherein the antagonist binds to aVP6. In one embodiment, the antagonist is a targeted binding agent, such as an antibody. The antagonist may bind to:

[0153] i) P6 alone;

[0154] ii) aVP6; or

[0155] iii) the aVP6/ligand complex,

[0156] or a combination of these. In one embodiment the antibody is able to antagonize the biological activity of aVP6 in vitro and in vivo. The antibody may be selected from fully human monoclonal antibody e.g., sc 264 RAD, sc 264 RAD/ADY, sc 188 SDM, sc 133, sc 133 TMT, sc 133 WDS, sc 133 TMT/WDS, sc 188, sc 254, sc or sc 298 or variants thereof.

[0157] In one embodiment the antagonist of the biological activity of aVP6 may bind to aVP6 and thereby prevent TGFPLAP mediated cell adhesion.

[0158] One embodiment is an antibody which binds to the same epitope or epitopes as fully human monoclonal antibody c 264 RAD, sc 264 RAD/ADY, sc 188 SDM, sc 133, sc 133 TMT, sc 133 WDS, sc 133 TMT/WDS, sc 188, sc 254, sc 264 or sc 298.

[0159] In one embodiment, the targeted binding agent binds aVP6 with a Kd of less than 100 nanomolar (nM). The targeted binding agent may bind with a Kd less than about 35 nanomolar (nM). The targeted binding agent may bind with a Kd less than about 25 nanomolar (nM). The targeted binding agent may bind with a Kd less than about 10 nanomolar (nM). In another embodiment, the targeted binding agent binds with a Kd of less than about 60 picomolar (pM).

[0160] One embodiment is an antibody-secreting plasma cell that produces the light chain and/or the heavy chain of antibody as described hereinabove. In one embodiment the plasma cell produces the light chain and/or the heavy chain of a fully human monoclonal antibody. In another embodiment the plasma cell produces the light chain and/or the heavy chain of the fully human monoclonal antibody c 264 RAD, sc 264 RAD/ADY, sc 188 SDM, sc 133, sc 133 TMT, sc 133 WDS, sc 133 TMT/WDS, sc 188, sc 254, sc 264 or sc 298. Alternatively the plasma cell may produce an antibody which SUBSTITUTE SHEET (RULE 26) binds to the same epitope or epitopes as fully human monoclonal antibody sc c 264 RAD, sc 264 RAD/ADY, sc 188 SDM, sc 133, sc 133 TMT, sc 133 WDS, sc 133 TMT/WDS, sc 188, sc 254, sc 264 or sc 298.

[0161] Another embodiment is a nucleic acid molecule encoding the light chain or the heavy chain of an antibody as described hereinabove. In one embodiment the nucleic acid molecule encodes the light chain or the heavy chain of a fully human monoclonal antibody. Still another embodiment is a nucleic acid molecule encoding the light chain or the heavy chain of a fully human monoclonal antibody selected from antibodies c 264 RAD, sc 264 RAD/ADY, sc 188 SDM, sc 133, sc 133 TMT, sc 133 WDS, sc 133 TMT/WDS, sc 188, sc 254, sc 264 or sc 298.

[0162] Another embodiment is a vector comprising a nucleic acid molecule or molecules as described hereinabove, wherein the vector encodes a light chain and/or a heavy chain of an antibody as defined hereinabove.

[0163] Yet another embodiment is a host cell comprising a vector as described hereinabove. Alternatively the host cell may comprise more than one vector.

[0164] In addition, one embodiment is a method of producing an antibody by culturing host cells under conditions wherein a nucleic acid molecule is expressed to produce the antibody, followed by recovery of the antibody.

[0165] One embodiment includes a method of making an antibody by transfecting at least one host cell with at least one nucleic acid molecule encoding the antibody as described hereinabove, expressing the nucleic acid molecule in the host cell and isolating the antibody.

[0166] Another aspect includes a method of antagonising the biological activity of aVI36 comprising administering an antagonist as described herein. The method may include selecting an animal in need of treatment for an aVI36 related disease or disorder, and administering to the animal a therapeutically effective dose of an antagonist of the biological activity of aVI36.

[0167] Another aspect includes a method of antagonising the biological activity of aVI36 comprising administering an antibody as described hereinabove. The method may include selecting an animal in need of treatment for an aVI36 related disease or disorder, and administering to said animal a therapeutically effective dose of an antibody which antagonises the biological activity of aVI36.

SUBSTITUTE SHEET (RULE 26)

[0168] According to another aspect there is provided a method of treating an aVI36 related disease or disorder in a mammal comprising administering a therapeutically effective amount of an antagonist of the biological activity of aVI36. The method may include selecting an animal in need of treatment for an aVI36 related disease or disorder, and administering to said animal a therapeutically effective dose of an antagonist of the biological activity of aVI36.

[0169] According to another aspect there is provided a method of treating an aVI36 disease or disorder in a mammal comprising administering a therapeutically effective amount of an antibody which antagonizes the biological activity of aVI36. The method may include selecting an animal in need of treatment for an aVI36 related disease or disorder, and administering to said animal a therapeutically effective dose of an antibody which antagonises the biological activity of aVI36. The antibody can be administered alone, or can be administered in combination with additional antibodies or chemotherapeutic drug or radiation therapy.

[0170] According to another aspect there is provided a method of treating cancer in a mammal comprising administering a therapeutically effective amount of an antagonist of the biological activity of aVI36. The method may include selecting an animal in need of treatment for cancer, and administering to said animal a therapeutically effective dose of an antagonist which antagonises the biological activity of aVI36. The antagonist can be administered alone, or can be administered in combination with additional antibodies or chemotherapeutic drug or radiation therapy.

[0171] According to another aspect there is provided a method of treating cancer in a mammal comprising administering a therapeutically effective amount of an antibody which antagonizes the biological activity of aVI36. The method may include selecting an animal in need of treatment for cancer, and administering to said animal a therapeutically effective dose of an antibody which antagonises the biological activity of aVI36. The antibody can be administered alone, or can be administered in combination with additional antibodies or chemotherapeutic drug or radiation therapy.

[0172] According to another aspect there is provided the use of an antagonist of the biological activity of aVI36 for the manufacture of a medicament for the treatment of an aVI36 related disease or disorder.

SUBSTITUTE SHEET (RULE 26)

[0173] According to another aspect there is provided the use of an antibody which antagonizes the biological activity of aVI36 for the manufacture of a medicament for the treatment of an aVI36 related disease or disorder.

[0174] One embodiment is particularly suitable for use in antagonizing aVI36, in patients with a tumor which is dependent alone, or in part, on aVI36 integrin.

[0175] Another embodiment includes an assay kit for detecting aVI36 in mammalian tissues, cells, or body fluids to screen for an aVI36 related disease or disorder.
The kit includes an antibody that binds to aVI36 and a means for indicating the reaction of the antibody with aVI36, if present. The antibody may be a monoclonal antibody. In one embodiment, the antibody that binds aVI36 is labeled. In another embodiment the antibody is an unlabeled primary antibody and the kit further includes a means for detecting the primary antibody. In one embodiment, the means includes a labeled second antibody that is an anti-immunoglobulin. In one aspect, the antibody is labeled with a marker chosen from a fluorochrome, an enzyme, a radionuclide and a radio-opaque material.

[0176] Further embodiments, features, and the like regarding anti-aVI36 antibodies are provided in additional detail below.
A. Human Antibodies and Humanization of Antibodies

[0177] Human antibodies avoid some of the problems associated with antibodies that possess murine or rat variable and/or constant regions. The presence of such murine or rat derived proteins can lead to the rapid clearance of the antibodies or can lead to the generation of an immune response against the antibody by a patient. In order to avoid the utilization of murine or rat derived antibodies, fully human antibodies can be generated through the introduction of functional human antibody loci into a rodent, other mammal or animal so that the rodent, other mammal or animal produces fully human antibodies.

[0178] One method for generating fully human antibodies is through the use of XenoMouse strains of mice that have been engineered to contain up to but less than 1000 kb-sized germline configured fragments of the human heavy chain locus and kappa light chain locus. See Mendez et al., Nature Genetics 15:146-156 (1997) and Green and Jakobovits J. Exp. Med. 188:483-495 (1998). The XenoMouse strains are available from Amgen, Inc. (Fremont, CA).

SUBSTITUTE SHEET (RULE 26)

[0179] The production of the XenoMouse strains of mice is further discussed and delineated in U.S. Patent Application Serial Nos. 07/466,008, filed January 12, 1990, 07/610,515, filed November 8, 1990, 07/919,297, filed July 24, 1992, 07/922,649, filed July 30, 1992, 08/031,801, filed March 15, 1993, 08/112,848, filed August 27, 1993, 08/234,145, filed April 28, 1994, 08/376,279, filed January 20, 1995, 08/430, 938, filed April 27, 1995, 08/464,584, filed June 5, 1995, 08/464,582, filed June 5, 1995, 08/463,191, filed June 5, 1995, 08/462,837, filed June 5, 1995, 08/486,853, filed June 5, 1995, 08/486,857, filed June 5, 1995, 08/486,859, filed June 5, 1995, 08/462,513, filed June 5, 1995, 08/724,752, filed October 2, 1996, 08/759,620, filed December 3, 1996, U.S. Publication 2003/0093820, filed November 30, 2001 and U.S. Patent Nos.
6,162,963, 6,150,584, 6,114,598, 6,075,181, and 5,939,598 and Japanese Patent Nos. 3 068 180 B2, 3 068 506 B2, and 3 068 507 B2. See also European Patent No., EP 0 151 Bl, grant published June 12, 1996, International Patent Application No., WO
94/02602, published February 3, 1994, International Patent Application No., WO

96/34096, published October 31, 1996, WO 98/24893, published June 11, 1998, WO

00/76310, published December 21, 2000. The disclosures of each of the above-cited patents, applications, and references are hereby incorporated by reference in their entirety.

[0180] In an alternative approach, others, including GenPharm International, Inc., have utilized a "minilocus" approach. In the minilocus approach, an exogenous Ig locus is mimicked through the inclusion of pieces (individual genes) from the Ig locus.
Thus, one or more VH genes, one or more DH genes, one or more hi genes, a mu constant region, and usually a second constant region (optionally a gamma constant region) are formed into a construct for insertion into an animal. This approach is described in U.S.
Patent No. 5,545,807 to Surani et al., and U.S. Patent Nos. 5,545,806, 5,625,825, 5,625,126, 5,633,425, 5,661,016, 5,770,429, 5,789,650, 5,814,318, 5,877,397, 5,874,299, and 6,255,458 each to Lonberg and Kay, U.S. Patent No. 5,591,669 and 6,023.010 to Krimpenfort and Berns, U.S. Patent Nos. 5,612,205, 5,721,367, and 5,789,215 to Berns et al., and U.S. Patent No. 5,643,763 to Choi and Dunn, and GenPharm International U.S.
Patent Application Serial Nos. 07/574,748, filed August 29, 1990, 07/575,962, filed August 31, 1990, 07/810,279, filed December 17, 1991, 07/853,408, filed March 18, 1992, 07/904,068, filed June 23, 1992, 07/990,860, filed December 16, 1992, 08/053,131, filed April 26, 1993, 08/096,762, filed July 22, 1993, 08/155,301, filed November 18, 1993, 08/161,739, filed December 3, 1993, 08/165,699, filed December 10, 1993, SUBSTITUTE SHEET (RULE 26) 08/209,741, filed March 9, 1994, the disclosures of which are hereby incorporated by reference. See also European Patent No. 0 546 073 Bl, International Patent Application Nos. WO 92/03918, WO 92/22645, WO 92/22647, WO 92/22670, WO 93/12227, WO
94/00569, WO 94/25585, WO 96/14436, WO 97/13852, and WO 98/24884 and U.S.
Patent No. 5,981,175, the disclosures of which are hereby incorporated by reference in their entirety. See further Taylor et al., 1992, Chen et al., 1993, Tuaillon et al., 1993, Choi et al., 1993, Lonberg et al., (1994), Taylor et al., (1994), and Tuaillon et al., (1995), Fishwild et al., (1996), the disclosures of which are hereby incorporated by reference in their entirety.

[0181] Kirin has also demonstrated the generation of human antibodies from mice in which, through microcell fusion, large pieces of chromosomes, or entire chromosomes, have been introduced. See European Patent Application Nos. 773 288 and 843 961, the disclosures of which are hereby incorporated by reference.
Additionally, KM¨ mice, which are the result of cross-breeding of Kirin's Tc mice with Medarex's minilocus (Humab) mice have been generated. These mice possess the human IgH
transchromosome of the Kirin mice and the kappa chain transgene of the Genpharm mice (Ishida et al., Cloning Stem Cells, (2002) 4:91-102).

[0182] Human antibodies can also be derived by in vitro methods. Suitable examples include but are not limited to phage display (CAT, Morphosys, Dyax, Biosite/Medarex, Xoma, Symphogen, Alexion (formerly Proliferon), Affimed) ribosome display (CAT), yeast display, and the like.
B. Preparation of Antibodies

[0183] Antibodies, as described herein, were prepared through the utilization of the XenoMouse technology, as described below. Such mice, then, are capable of producing human immunoglobulin molecules and antibodies and are deficient in the production of murine immunoglobulin molecules and antibodies. Technologies utilized for achieving the same are disclosed in the patents, applications, and references disclosed in the background section herein. In particular, however, an embodiment of transgenic production of mice and antibodies therefrom is disclosed in U.S. Patent Application Serial No. 08/759,620, filed December 3, 1996 and International Patent Application Nos. WO
98/24893, published June 11, 1998 and WO 00/76310, published December 21, 2000, the SUBSTITUTE SHEET (RULE 26) disclosures of which are hereby incorporated by reference. See also Mendez et al., Nature Genetics 15:146-156 (1997), the disclosure of which is hereby incorporated by reference.

[0184] Through the use of such technology, fully human monoclonal antibodies to a variety of antigens have been produced. Essentially, XenoMouse lines of mice are immunized with an antigen of interest (e.g. aVI36), lymphatic cells (such as B-cells) are recovered from the hyper-immunized mice, and the recovered lymphocytes are fused with a myeloid-type cell line to prepare immortal hybridoma cell lines. These hybridoma cell lines are screened and selected to identify hybridoma cell lines that produced antibodies specific to the antigen of interest. Provided herein are methods for the production of multiple hybridoma cell lines that produce antibodies specific to aVI36.
Further, provided herein are characterization of the antibodies produced by such cell lines, including nucleotide and amino acid sequence analyses of the heavy and light chains of such antibodies.

[0185] Alternatively, instead of being fused to myeloma cells to generate hybridomas, B cells can be directly assayed. For example, CD19+ B cells can be isolated from hyperimmune XenoMouse mice and allowed to proliferate and differentiate into antibody-secreting plasma cells. Antibodies from the cell supernatants are then screened by ELISA for reactivity against the aVI36 immunogen. The supernatants might also be screened for immunoreactivity against fragments of aVI36 to further map the different antibodies for binding to domains of functional interest on aVI36. The antibodies may also be screened against other related human integrins and against the rat, the mouse, and non-human primate, such as Cynomolgus monkey, orthologues of aVI36, the last to determine species cross-reactivity. B cells from wells containing antibodies of interest may be immortalized by various methods including fusion to make hybridomas either from individual or from pooled wells, or by infection with EBV or transfection by known immortalizing genes and then plating in suitable medium. Alternatively, single plasma cells secreting antibodies with the desired specificities are then isolated using a aVI36-specific hemolytic plaque assay (see for example Babcook et al., Proc. Natl.
Acad. Sci.
USA 93:7843-48 (1996)). Cells targeted for lysis may be sheep red blood cells (SRBCs) coated with the aVI36 antigen.

[0186] In the presence of a B-cell culture containing plasma cells secreting the immunoglobulin of interest and complement, the formation of a plaque indicates specific aVI36-mediated lysis of the sheep red blood cells surrounding the plasma cell of interest.

SUBSTITUTE SHEET (RULE 26) The single antigen-specific plasma cell in the center of the plaque can be isolated and the genetic information that encodes the specificity of the antibody is isolated from the single plasma cell. Using reverse-transcription followed by PCR (RT-PCR), the DNA
encoding the heavy and light chain variable regions of the antibody can be cloned. Such cloned DNA can then be further inserted into a suitable expression vector, a vector cassette such as a pcDNA, or a pcDNA vector containing the constant domains of immunglobulin heavy and light chain. The generated vector can then be transfected into host cells, e.g., HEK293 cells, CHO cells, and cultured in conventional nutrient media modified as appropriate for inducing transcription, selecting transformants, or amplifying the genes encoding the desired sequences.

[0187] In general, antibodies produced by the fused hybridomas were human IgG2 heavy chains with fully human kappa or lambda light chains. Antibodies described herein possess human IgG4 heavy chains as well as IgG2 heavy chains.
Antibodies can also be of other human isotypes, including IgGl. The antibodies possessed high affinities, typically possessing a Kd of from about 10-6 through about 10-12 M or below, when measured by solid phase and solution phase techniques. Antibodies possessing a Kd of at least 10-11 M may inhibit the activity of aVI36.

[0188] As will be appreciated, antibodies can be expressed in cell lines other than hybridoma cell lines. Sequences encoding particular antibodies can be used to transform a suitable mammalian host cell. Transformation can be by any known method for introducing polynucleotides into a host cell, including, for example packaging the polynucleotide in a virus (or into a viral vector) and transducing a host cell with the virus (or vector) or by transfection procedures known in the art, as exemplified by U.S. Patent Nos. 4,399,216, 4,912,040, 4,740,461, and 4,959,455 (which patents are hereby incorporated herein by reference). The transformation procedure used depends upon the host to be transformed. Methods for introducing heterologous polynucleotides into mammalian cells are well known in the art and include dextran-mediated transfection, calcium phosphate precipitation, polybrene mediated transfection, protoplast fusion, electroporation, encapsulation of the polynucleotide(s) in liposomes, and direct microinjection of the DNA into nuclei.

[0189] Mammalian cell lines available as hosts for expression are well known in the art and include many immortalized cell lines available from the American Type Culture Collection (ATCC), including but not limited to Chinese hamster ovary (CHO) SUBSTITUTE SHEET (RULE 26) cells, HeLa cells, baby hamster kidney (BHK) cells, monkey kidney cells (COS), human hepatocellular carcinoma cells (e.g., Hep G2), human epithelial kidney 293 cells, and a number of other cell lines. Cell lines may be selected through determining which cell lines have high expression levels and produce antibodies with constitutive aVI36 binding properties.

[0190] Based on the ability of mAbs to significantly neutralize aVI36 activity (as demonstrated in the Examples below), these antibodies will have therapeutic effects in treating symptoms and conditions resulting from aVI36 expression. In specific embodiments, the antibodies and methods herein relate to the treatment of symptoms resulting from aVI36 induced cell adhesion or signaling induced as a result of aVI36 interaction with its ligands

[0191] According to another aspect there is provided a pharmaceutical composition comprising an antagonist of the biological activity of aVI36, and a pharmaceutically acceptable carrier. In one embodiment the antagonist comprises an antibody. According to another aspect there is provided a pharmaceutical composition comprising an antagonist of the biological activity of aVI36, and a pharmaceutically acceptable carrier. In one embodiment the antagonist comprises an antibody.

[0192] Anti-aVI36 antibodies are useful in the detection of aVI36 in patient samples and accordingly are useful as diagnostics for disease states as described herein.
In addition, based on their ability to significantly inhibit aVI36 activity (as demonstrated in the Examples below), anti-aVI36 antibodies have therapeutic effects in treating symptoms and conditions resulting from aVI36 expression. In specific embodiments, the antibodies and methods herein relate to the treatment of symptoms resulting from aVI36 induced cell adhesion. Further embodiments involve using the antibodies and methods described herein to treat an aVI36 related disease or disorder including neoplastic diseases, such as, melanoma, small cell lung cancer, non-small cell lung cancer, glioma, hepatocellular (liver) carcinoma, thyroid tumor, gastric (stomach) cancer, prostate cancer, breast cancer, ovarian cancer, bladder cancer, lung cancer, glioblastoma, endometrial cancer, kidney cancer, colon cancer, and pancreatic cancer.
C. Therapeutic Administration and Formulations

[0193] Embodiments include sterile pharmaceutical formulations of anti-aVI36 antibodies that are useful as treatments for diseases. Such formulations would inhibit the SUBSTITUTE SHEET (RULE 26) binding of ligands to the aVI36 integrin, thereby effectively treating pathological conditions where, for example, tissue aVI36 is abnormally elevated. Anti-aVI36 antibodies may possess adequate affinity to potently inhibit aVI36 activity, and may have an adequate duration of action to allow for infrequent dosing in humans. A
prolonged duration of action will allow for less frequent and more convenient dosing schedules by alternate parenteral routes such as subcutaneous or intramuscular injection.

[0194] Sterile formulations can be created, for example, by filtration through sterile filtration membranes, prior to or following lyophilization and reconstitution of the antibody. The antibody ordinarily will be stored in lyophilized form or in solution.
Therapeutic antibody compositions generally are placed into a container having a sterile access port, for example, an intravenous solution bag or vial having an adapter that allows retrieval of the formulation, such as a stopper pierceable by a hypodermic injection needle.

[0195] The route of antibody administration is in accord with known methods, e.g., injection or infusion by intravenous, intraperitoneal, intracerebral, intramuscular, intraocular, intraarterial, intrathecal, inhalation or intralesional routes, direct injection to a tumor site, or by sustained release systems as noted below. The antibody may be administered continuously by infusion or by bolus injection.

[0196] An effective amount of antibody to be employed therapeutically will depend, for example, upon the therapeutic objectives, the route of administration, and the condition of the patient. Accordingly, the therapist may titer the dosage and modify the route of administration to obtain the optimal therapeutic effect. In one aspect, the clinician will administer antibody until a dosage is reached that achieves the desired effect. The progress of this therapy is easily monitored by conventional assays or by the assays described herein.

[0197] Antibodies, as described herein, can be prepared in a mixture with a pharmaceutically acceptable carrier. This therapeutic composition can be administered intravenously or through the nose or lung, optionally as a liquid or powder aerosol (lyophilized). The composition may also be administered parenterally or subcutaneously as desired. When administered systemically, the therapeutic composition should be sterile, pyrogen-free and in a parenterally acceptable solution having due regard for pH, isotonicity, and stability. These conditions are known to those skilled in the art. Briefly, dosage formulations of the compounds described herein are prepared for storage or SUBSTITUTE SHEET (RULE 26) administration by mixing the compound having the desired degree of purity with pharmaceutically acceptable carriers, excipients, or stabilizers. Such materials are non-toxic to the recipients at the dosages and concentrations employed, and include buffers such as TRIS HC1, phosphate, citrate, acetate and other organic acid salts;
antioxidants such as ascorbic acid; low molecular weight (less than about ten residues) peptides such as polyarginine, proteins, such as serum albumin, gelatin, or immunoglobulins;

hydrophilic polymers such as polyvinylpyrrolidinone; amino acids such as glycine, glutamic acid, aspartic acid, or arginine; monosaccharides, disaccharides, and other carbohydrates including cellulose or its derivatives, glucose, mannose, or dextrins;
chelating agents such as EDTA; sugar alcohols such as mannitol or sorbitol;
counterions such as sodium and/or nonionic surfactants such as TWEEN, PLURONICS or polyethyleneglycol.

[0198] Sterile compositions for injection can be formulated according to conventional pharmaceutical practice as described in Remington: The Science and Practice of Pharmacy (20th ed, Lippincott Williams & Wilkens Publishers (2003)). For example, dissolution or suspension of the active compound in a pharmaceutically acceptable carrier such as water or naturally occurring vegetable oil like sesame, peanut, or cottonseed oil or a synthetic fatty vehicle like ethyl oleate or the like may be desired.
Buffers, preservatives, antioxidants and the like can be incorporated according to accepted pharmaceutical practice.

[0199] Suitable examples of sustained-release preparations include semipermeable matrices of solid hydrophobic polymers containing the polypeptide, which matrices are in the form of shaped articles, films or microcapsules. Examples of sustained-release matrices include polyesters, hydrogels (e.g., poly(2-hydroxyethyl-methacrylate) as described by Langer et al., J. Biomed Mater. Res., (1981) 15:167-277 and Langer, Chem. Tech., (1982) 12:98-105, or poly(vinylalcohol)), polylactides (U.S.
Pat. No. 3,773,919, EP 58,481), copolymers of L-glutamic acid and gamma ethyl-L-glutamate (Sidman et al., Biopolymers, (1983) 22:547-556), non-degradable ethylene-vinyl acetate (Langer et al., supra), degradable lactic acid-glycolic acid copolymers such as the LUPRON DepotTM (injectable microspheres composed of lactic acid-glycolic acid copolymer and leuprolide acetate), and poly-D-(-)-3-hydroxybutyric acid (EP
133,988).

[0200] While polymers such as ethylene-vinyl acetate and lactic acid-glycolic acid enable release of molecules for over 100 days, certain hydrogels release proteins for SUBSTITUTE SHEET (RULE 26) shorter time periods. When encapsulated proteins remain in the body for a long time, they may denature or aggregate as a result of exposure to moisture at 37 C, resulting in a loss of biological activity and possible changes in immunogenicity. Rational strategies can be devised for protein stabilization depending on the mechanism involved. For example, if the aggregation mechanism is discovered to be intermolecular S-S bond formation through disulfide interchange, stabilization may be achieved by modifying sulfhydryl residues, lyophilizing from acidic solutions, controlling moisture content, using appropriate additives, and developing specific polymer matrix compositions.

[0201] The antibodies also encompass antibodies that have half-lives (e.g., serum half-lives) in a mammal, optionally a human, of greater than that of an unmodified antibody. In one embodiment, said antibody anybody half-life is greater than 15 days, greater than 20 days, greater than 25 days, greater than 30 days, greater than 35 days, greater than 40 days, greater than 45 days, greater than 2 months, greater than 3 months, greater than 4 months, or greater than 5 months. The increased half-lives of the antibodies herein or fragments thereof in a mammal, optionally a human, result in a higher serum titer of said antibodies or antibody fragments in the mammal, and thus, reduce the frequency of the administration of said antibodies or antibody fragments and/or reduces the concentration of said antibodies or antibody fragments to be administered.
Antibodies or fragments thereof having increased in vivo half-lives can be generated by techniques known to those of skill in the art. For example, antibodies or fragments thereof with increased in vivo half-lives can be generated by modifying (e.g., substituting, deleting or adding) amino acid residues identified as involved in the interaction between the Fc domain and the FcRn receptor (see, e.g., International Publication Nos. WO
97/34631 and WO 02/060919, which are incorporated herein by reference in their entireties).

Antibodies or fragments thereof with increased in vivo half-lives can be generated by attaching to said antibodies or antibody fragments polymer molecules such as high molecular weight polyethyleneglycol (PEG). PEG can be attached to said antibodies or antibody fragments with or without a multifunctional linker either through site-specific conjugation of the PEG to the N- or C-terminus of said antibodies or antibody fragments or via epsilon-amino groups present on lysine residues. Linear or branched polymer derivatization that results in minimal loss of biological activity will be used. The degree of conjugation will be closely monitored by SDS-PAGE and mass spectrometry to ensure SUBSTITUTE SHEET (RULE 26) proper conjugation of PEG molecules to the antibodies. Unreacted PEG can be separated from antibody-PEG conjugates by, e.g., size exclusion or ion-exchange chromatography.

[0202] Sustained-released compositions also include preparations of crystals of the antibody suspended in suitable formulations capable of maintaining crystals in suspension. These preparations when injected subcutaneously or intraperitonealy can produce a sustained release effect. Other compositions also include liposomally entrapped antibodies. Liposomes containing such antibodies are prepared by methods known per se:
U.S. Pat. No. DE 3,218,121; Epstein et al., Proc. Natl. Acad. Sci. USA, (1985) 82:3688-3692; Hwang et al., Proc. Natl. Acad. Sci. USA, (1980) 77:4030-4034; EP
52,322; EP
36,676; EP 88,046; EP 143,949; 142,641; Japanese patent application 83-118008;
U.S.
Pat. Nos. 4,485,045 and 4,544,545; and EP 102,324.

[0203] The dosage of the antibody formulation for a given patient will be determined by the attending physician taking into consideration various factors known to modify the action of drugs including severity and type of disease, body weight, sex, diet, time and route of administration, other medications and other relevant clinical factors.
Therapeutically effective dosages may be determined by either in vitro or in vivo methods.

[0204] An effective amount of the antibodies, described herein, to be employed therapeutically will depend, for example, upon the therapeutic objectives, the route of administration, and the condition of the patient. Accordingly, the therapist may titer the dosage and modify the route of administration as required to obtain the optimal therapeutic effect. A typical daily dosage might range from about 0.001mg/kg to up to 100mg/kg or more, depending on the factors mentioned above. Typically, the clinician will administer the therapeutic antibody until a dosage is reached that achieves the desired effect. The progress of this therapy is easily monitored by conventional assays or as described herein.

[0205] It will be appreciated that administration of therapeutic entities in accordance with the compositions and methods herein will be administered with suitable carriers, excipients, and other agents that are incorporated into formulations to provide improved transfer, delivery, tolerance, and the like. These formulations include, for example, powders, pastes, ointments, jellies, waxes, oils, lipids, lipid (cationic or anionic) containing vesicles (such as LipofectinTh4), DNA conjugates, anhydrous absorption pastes, oil-in-water and water-in-oil emulsions, emulsions carbowax (polyethylene SUBSTITUTE SHEET (RULE 26) glycols of various molecular weights), semi-solid gels, and semi-solid mixtures containing carbowax. Any of the foregoing mixtures may be appropriate in treatments and therapies, provided that the active ingredient in the formulation is not inactivated by the formulation and the formulation is physiologically compatible and tolerable with the route of administration. See also Baldrick P. "Pharmaceutical excipient development: the need for preclinical guidance." Regul. Toxicol. Pharmacol. 32(2):210-8 (2000), Wang W.
"Lyophilization and development of solid protein pharmaceuticals." Int. J.
Phann. 203(1-2):1-60 (2000), Charman WN "Lipids, lipophilic drugs, and oral drug delivery-some emerging concepts." J Pharm Sci .89(8):967-78 (2000), Powell et al., "Compendium of excipients for parenteral formulations" PDA J Pharm Sci Technol. 52:238-311(1998) and the citations therein for additional information related to formulations, excipients and carriers well known to pharmaceutical chemists.
D. Design and Generation of Other Therapeutics

[0206] In accordance with the present embodiments and based on the activity of the antibodies that are produced and characterized herein with respect to aVI36, the design of other therapeutic modalities beyond antibody moieties is facilitated. Such modalities include, without limitation, advanced antibody therapeutics, such as bispecific antibodies, immunotoxins, and radiolabeled therapeutics, single domain antibodies, generation of peptide therapeutics, aVI36 binding domains in novel scaffolds, gene therapies, particularly intrabodies, antisense therapeutics, and small molecules.

[0207] In connection with the generation of advanced antibody therapeutics, where complement fixation is a desirable attribute, it may be possible to sidestep the dependence on complement for cell killing through the use of bispecific antibodies, immunotoxins, or radiolabels, for example.

[0208] Bispecific antibodies can be generated that comprise (i) two antibodies one with a specificity to aVI36 and another to a second molecule that are conjugated together, (ii) a single antibody that has one chain specific to aVI36 and a second chain specific to a second molecule, or (iii) a single chain antibody that has specificity to aVI36 and the other molecule. Such bispecific antibodies can be generated using techniques that are well known; for example, in connection with (i) and (ii) see e.g., Fanger et al., Immunol Methods 4:72-81 (1994) and Wright and Harris, supra. and in connection with (iii) see e.g., Traunecker et al., Int. J. Cancer (Suppl.) 7:51-52 (1992). In each case, the SUBSTITUTE SHEET (RULE 26) second specificity can be made to the heavy chain activation receptors, including, without limitation, CD16 or CD64 (see e.g., Deo et al., Immunol. Today 18:127 (1997)) or CD89 (see e.g., Valerius et al., Blood 90:4485-4492 (1997)).

[0209] In connection with immunotoxins, antibodies can be modified to act as immunotoxins utilizing techniques that are well known in the art. See e.g., Vitetta Immunol Today 14:252 (1993). See also U.S. Patent No. 5,194,594. In connection with the preparation of radiolabeled antibodies, such modified antibodies can also be readily prepared utilizing techniques that are well known in the art. See e.g., Junghans et al., in Cancer Chemotherapy and Biotherapy 655-686 (2d edition, Chafner and Longo, eds., Lippincott Raven (1996)). See also U.S. Patent Nos. 4,681,581, 4,735,210, 5,101,827, 5,102,990 (RE 35,500), 5,648,471, and 5,697,902.

[0210] An antigen binding site may be provided by means of arrangement of CDRs on non-antibody protein scaffolds, such as fibronectin or cytochrome B
etc. (Haan & Maggos (2004) BioCentury, 12(5): A1-A6; Koide et al., (1998) Journal of Molecular Biology, 284: 1141-1151; Nygren et al., (1997) Current Opinion in Structural Biology, 7:
463-469) or by randomising or mutating amino acid residues of a loop within a protein scaffold to confer binding specificity for a desired target. Scaffolds for engineering novel binding sites in proteins have been reviewed in detail by Nygren et al., (Nygren et al., (1997) Current Opinion in Structural Biology, 7: 463-469). Protein scaffolds for antibody mimics are disclosed in WO/0034784, which is herein incorporated by reference in its entirety, in which the inventors describe proteins (antibody mimics) that include a fibronectin type III domain having at least one randomised loop. A suitable scaffold into which to graft one or more CDRs, e.g. a set of HCDRs, may be provided by any domain member of the immunoglobulin gene superfamily. The scaffold may be a human or non-human protein. An advantage of a non-antibody protein scaffold is that it may provide an antigen-binding site in a scaffold molecule that is smaller and/or easier to manufacture than at least some antibody molecules. Small size of a binding agent may confer useful physiological properties, such as an ability to enter cells, penetrate deep into tissues or reach targets within other structures, or to bind within protein cavities of the target antigen. Use of antigen binding sites in non-antibody protein scaffolds is reviewed in Wess, 2004 (Wess, L. In: BioCentury, The Bernstein Report on BioBusiness, 12(42), Al-A7, 2004). Typical are proteins having a stable backbone and one or more variable loops, in which the amino acid sequence of the loop or loops is specifically or randomly mutated SUBSTITUTE SHEET (RULE 26) to create an antigen-binding site that binds the target antigen. Such proteins include the IgG-binding domains of protein A from S. aureus, transferrin, albumin, tetranectin, fibronectin (e.g. 10th fibronectin type III domain), lipocalins as well as gamma-crystalline and other AffilinTM scaffolds (Scil Proteins). Examples of other approaches include synthetic "Microbodies" based on cyclotides - small proteins having intra-molecular disulphide bonds, Microproteins (VersabodiesTM, Amunix) and ankyrin repeat proteins (DARPins, Molecular Partners).

[0211] In addition to antibody sequences and/or an antigen-binding site, a binding agent may comprise other amino acids, e.g. forming a peptide or polypeptide, such as a folded domain, or to impart to the molecule another functional characteristic in addition to ability to bind antigen. Binding agents may carry a detectable label, or may be conjugated to a toxin or a targeting moiety or enzyme (e.g. via a peptidyl bond or linker).
For example, a binding agent may comprise a catalytic site (e.g. in an enzyme domain) as well as an antigen binding site, wherein the antigen binding site binds to the antigen and thus targets the catalytic site to the antigen. The catalytic site may inhibit biological function of the antigen, e.g. by cleavage.

[0212] Other embodiments will be apparent to those skilled in the art from consideration of the specification and practice disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit being indicated by the following claims.
EXAMPLES
Example 1. Materials and Methods Clinical samples

[0213] Two independent cohorts of breast cancer samples were analysed following REMARK guidelines (23). One comprised 1,795 consecutive cases from the Nottingham Tenovus Breast Carcinoma Series (Nottingham Cohort) of women aged <70 years presenting from 1986-1998 (24,25). Data were available on tumor type, histological grade, size, lymph node (LN) status, ER-, PR- and HER2-status, cytokeratin (CK) profile, recurrence (local, regional and distant) and survival. The second cohort constituted 1,197 invasive cases from Guy's and St. Thomas' Breast Tissue Bank, London (London Cohort). Patients underwent surgery from 1960-1998 (98% from 1975 onwards).
Data were available on tumor type, grade, LN status, ER-, PR- and HER2-status, disease free-SUBSTITUTE SHEET (RULE 26) and overall-survival. A summary of clinicopathological data is presented (Figure 10). All studies were approved by the North East London Research Ethics Committee.
Immunohistochemical analysis

[0214] Immunohistochemistry utilized 4 i.tm, formalin-fixed, paraffin-embedded serial sections of tissue microarrays (TMA). Each sample was represented by a minimum of two x 0.6mm tumor cores. A standard Avidin-Biotin Complex technique (Vectastain Elite ABC Kit, Vector Laboratories, Peterborough, UK) was employed, with citrate buffer microwave antigen retrieval for cytokeratin 5/6 (Sigma, UK) and cytokeratin 14 (Sigma, UK). The protocol used for avl36 integrin (mAb 6.2G2, Biogen Idec) was described previously (16). Normal breast (n=15) constituted a positive control for cytokeratin antibodies while mouse IgG represented a negative control.
Integrin avl36 staining was scored as the sum of the extent of tumor cells staining (0,<25%=1,25-50%=2,50-75%=3,>75%=4) and intensity (0=negative, 1=weak, 2=moderate, 3=strong);
giving a final score range of 0-7. An example of strong avI36 staining is shown in Figure 1B. Each tumor core was scored by two independent pathologists; final score represents mean of the two readings. A pre-determined cut-off, between cases showing strong expression (scores>5) and those showing moderate or negative staining (scores<5), was used in all analyses. For CK5/6 and CK14 expression, cases were considered positive if >10% staining occurred (25).
METABRIC cohort preprocessing

[0215] This study makes use of the METABRIC data generated by the Molecular Taxonomy of Breast Cancer International Consortium (26). Funding for the project was provided by Cancer Research UK and the British Columbia Cancer Agency Branch. Breast cancer METABRIC dataset was preprocessed, summarized and quantile-normalized from the raw expression files generated by Illumina BeadStudio. (R
packages:
beadarray v2.4.2 and illuminaHuman v3.db_1.12.2). Raw METABRIC files were downloaded from European genome-phenome archive (EGA) (study id:
EGAS00000000083). Raw data files of one METABRIC sample was not available at the time of our analysis, therefore it was excluded. All preprocessing was performed in R
statistical environment v2.14.1.

SUBSTITUTE SHEET (RULE 26) Survival analysis

[0216] HER2+ patients in the London and Nottingham clinical cohorts were dichotomised into low- and high-risk groups using avI36 protein expression (Low-risk avI36<5, High-risk avI36>5). Survival analysis was performed in R statistical environment v.2.14.1 (R package: survival v2.36-14). Hazard ratio was estimated by fitting univariate Cox proportional hazards model, and significance of difference between the survival of risk groups were computed using Logrank test. Likewise, gene expression-derived HER2+ patients in the METABRIC cohort were analysed using ITGB6 expression profile. The riskgroup dichotomisation threshold for ITGB6 expression in METABRIC
was established by using the proportion of low- and high-risk HER2+ patients determined by antibody studies of the London/Nottingham cohorts. Kaplan- Meier survival curves were drawn in R statistical environment v2.14.1.
Cell lines and drug sources

[0217] Twenty human breast cancer cell lines were analyzed for avI36-expression. Genetic identity of all lines was confirmed by LGC STR profiling (data not shown). Human breast cancer cell lines MCF-7 and MDA MB-468 cells were grown in DMEM containing 10% fetal bovine serum (FBS) and L-glutamine. MCF-7/neo-1 and MCF-7/HER2-18 were a kind gift from Prof. Hung, Texas, USA (37) Cell sources and media requirements are as detailed (37, 38, 39, 40). BT-474 cells were grown in RPMI
containing 10% FCS, L-glutamine and insulin (101Ag/m1).

[0218] Mouse monoclonal antibody 6.2G2 was a generous gift from Biogen Idec (Cambridge, MA, USA). IgG and avI36-blocking antibody 264RAD were generous gifts from Oncology iMED, AstraZeneca (Maccelsfield, U.K). Trastuzumab was a kind gift from Roche Pharmaceuticals. siRNA was supplied by Dharmacon (SMARTpool:
siGENOME, Thermo Scientific). Growth factors were supplied by Peprotech.
Transwell and mini organotypic invasion assays

[0219] For Transwell invasion assays, 5 x 104 cells were seeded per well posttreatment into 6.5mm diameter, 8 i.tm pore-sized Transwells (Corning BV) coated with 70 i.il BD Matrigel Basement Membrane matrix (Matrigel): media (1:2 ratio). Cells which invaded through Matrigel were counted after 72h using a CASY counter (Scharfe Systems, Germany). For the organotypic assays, 5 x 104 cells were seeded per well post-SUBSTITUTE SHEET (RULE 26) treatment onto 6.5mm diameter, 41.tm pore-sized Transwells with 1201,t1 collagen (Rat tail Collagen I, Marathon Laboratories):Matrigel mix (70:30) containing 5 x 104 MRC5/hTERT fibroblasts. Media was changed every 2 days for 5-6 days, gels were fixed in formal saline, paraffin embedded and sections hematoxylin and eosin stained. Invasion Index was calculated by multiplying the mean depth at 5 points on each gel by the area occupied by the invading cells. Analysis was performed using ImageJ 1 64 software.
Immunoblotting

[0220] Cells were lysed in NP-40 buffer post treatment and then subject to western blotting. Briefly, after quantification, 10-50pg of protein was loaded per lane, gels run and transferred to membrane. Non-specific binding was blocked by incubation in 5% non-fat milk in 0.1%TBS-Tween-20, lh, room temperature. Membranes were incubated with desired primary antibodies, overnight, 4 C. Figure 13 lists antibodies and suppliers. Analysis was performed using ImageJ 1 64 software.
Human tumor xenograft models

[0221] All animal experiments were approved by and followed Home Office Guidelines. For all animal studies, 264RAD and trastuzumab were dissolved in 1xPBS, at a final concentration of 10mg/kg. Estrogen pellets (0.25mg 60-day release, Innovative Research of America) were implanted subcutaneously into mice 24h prior to tumour cell injection. SCID-mice (a generous gift from Oncology iMED, AstraZeneca, Maccelsfield, U.K) or CD1 nu/nu mice (Charles River Laboratories) were inoculated subcutaneously with either 1x106 MCF-7/HER2-18 cells in 2001,t1 of PBS or 1x107 BT-474 cells in 1:1 PBS/Matrigel. When tumours were palpable (3-4mm3) or reached 100 or 200mm3, mice were randomized into treatment groups. Mice received bi-weekly intraperitoneal injections (10mg/kg in 200 i.il of PBS) of human IgG, 264RAD, trastuzumab or both 264RAD and trastuzumab. Tumors were measured with calipers bi-weekly in two directions and tumor volume calculated using the formula (width2 x length)/2.
Statistical analysis

[0222] Statistical significance in drug-treated versus control in vitro cultures was determined using the Student's t-test for 2 variables. For 3 or more variables data were analysed using one-way ANOVA with Bonferroni's Multiple Comparison Test using Prism GraphPad software (Systat Software, San Jose, CA, USA). For tumor xenograft SUBSTITUTE SHEET (RULE 26) models, individual growth curves were plotted and then a linear mixed model (27) was used to test for differences between the treatments. It was fitted by maximum likelihood using the nlme package in the statistical software R (R Development Core Team, 2010) 2.11.1. P values are from Wald tests. Survival of mice was measured using the Log-Rank test in Prism GraphPad. All statistical tests were two-sided.
Example 2. High co-expression of integrin 0[136 and HER2 predict poor survival from breast cancer.

[0223] We stained for aV136 expression (example staining Figure 1A) on tissue microarrays (TMAs) from two separate cohorts (London and Nottingham) totaling over 2000 women with breast cancer. The clinicopathological parameters and the correlation of aV136 expression with these parameters for these two cohorts are in shown in Figure 10 and 11, respectively. Normal breast tissue (n>15) lacked aV136 expression whereas high expression of aV136 was observed on 15%-16% of invasive ductal carcinoma (Figures 1A, 1B, and 11). There was a significant correlation between high expression of aV136 and poor survival (Figure 1C and 1D). Thus, 5-year survival dropped from 71.3% to 57% in the London cohort (Figure 1C; P=2.9x10-6) and from 73.5% to 53.2% in the Nottingham cohort (Figure 1 D; P=4.73x10-5) and this significant association between poor survival and high expression of aV136 extended for at least 15 years (Figure 6). Even after adjusting for tumor stage, size and grade aV136 remained an independent predictor of survival (P=0.03; combined cohort data). Data regarding tumor dissemination were available only for the Nottingham series where aV136 expression associated significantly with distant spread (P=0.02). Of 1026 aV136-negative cases, 317 (31%) had distant metastases, whereas of the corresponding 205 aV136-positive cases 81(40%) had distant metastases. Furthermore, aV136-positive cancers were significantly more likely to have spread to bone (P=0.04).

[0224] We also noted for both cohorts that there was a strong correlation between HER2 and high aV136 expression (P=0.001; Figure 11). Co-expression of high aV136 and HER2 proteins significantly reduced survival in the combined London and Nottingham cohorts (Figure 1 E; Hazard Ratio (HR) 3.43; P=3.98x10-12). The increased risk appeared to be controlled at the transcriptional level since analysis of the METABRIC Breast cancer expression database (>2000 cases (26)) confirmed that patients who had high ERBB2 (HER2) and ITGB6 (integrin 136 subunit) gene expression SUBSTITUTE SHEET (RULE 26) had significantly reduced survival (Figure 1F; HR=1.94, P=0.003). Thus, as there appeared to be correlations between HER2 and aV136 at both protein and mRNA
levels predicting poor survival from breast cancer, we investigated whether these two receptors co-operated to promote invasion and cancer.
Example 3. lntegrin aVI36 and HER2 both promote breast carcinoma invasion.

[0225] Using flow cytometry we screened 20 breast cancer cell lines for expression of aV136 and HER2 and their ability to invade through Matrigel (Figures 2A, 2B, and 12). We discovered 80% of cell lines expressed aV136 and of these we examined more closely the aV136/HER2 double-positive cell lines BT-474, MCF10A.CA1a (CAla) and the trastuzumab-resistant MCF-7/HER2-18 (HER2-18). Antibody blockade of aV136 (264RAD) or HER2 (trastuzumab, TRA) blocked invasion significantly (Figure 2C
and 2D). Similarly, siRNA to ITGB6 (Figure 2E) or ERBB2 (Figure 2F) also blocked invasion significantly. Since 264RAD also has some activity against aV138 we repeated these experiments with the aV136-specific antibody, 10D5, with similar results (Figure 7A). Combined antibody blockade of aV136 and HER2 did not decrease invasion beyond that achieved by single antibody blockade (Figure 2G), possibly suggesting that these receptors functioned through the same pathway. Proliferation of HER2-18 or CAla cells was not significantly changed by treatment with 264RAD, trastuzumab or a combination of both antibodies over the course of the Matrigel assays or after 7 days of treatment (Figure 7B). Proliferation was not significantly reduced in trastuzumab-sensitive BT-474 cells with any treatment over 3 days, although trastuzumab did reduce proliferation by ¨30% over 7 days; 264RAD did not significantly affect BT -474 proliferation over 3 or 7 days (data not shown).

[0226] Confocal microscopy revealed aV136 and HER2 co-localized in breast cancer cells (Figure 7C). However, the two proteins did not co-immunoprecitate, with or without Heregulin 131 (HRG13) stimulation, even when protein-protein cross-linking agents were added to strengthen any weak associations (data not shown).
Example 4. lntegrin aVI36 Mediates HER2 Driven Invasion.

[0227] To establish the relationship between aV136 and HER2 function we stimulated HER2 invasion by addition of HRG13 to induce HER2/3 heterodimerization and downstream signaling activation. HER3 is the preferred dimerization partner of SUBSTITUTE SHEET (RULE 26) HER2 in breast cancer (28) and confers poor survival. HRG13 is also a ligand for HER4, however the vast majority of signaling occurred via HER2/3 (data not shown).
This was confirmed in tumor xenografts, where P-HER4 expression was negligible with or without HRG13 (data not shown).

[0228] Figures 3A and 3B show that HRG13 significantly increased the invasive propensity of both HER2-18 and CAla cells and that this increased invasion could be inhibited by antibody blockade of HER2 (trastuzumab) or aV136 (264RAD). These data suggest that HER2-promoted invasion is mediated by aV136. In contrast, addition of HRG13 to BT -474 cells did not enhance invasive ability, suggesting that their promoted invasive propensity was at a maximum. However, blockade of aV136 or again suppressed their endogenous invasive propensity (Figure 3A and B).

[0229] To test invasion in a more physiologically relevant assay we tested our cell lines using the organotypic invasion assay, which allows tumor cells to invade into a fibroblast-rich collagen gel. We found that HER2-18 and BT-474 cells could not be adapted to the organotypic system so we tested CA 1 a cells. Figure 3C shows that both antibody blockade and siRNA knockdown of 136 or HER2 suppresses invasion significantly. Invasion was reduced by 67.45 12.53% with aV136 blockade and by 69.81 9.85% with HER2 blockade (invasion quantified as 'Invasion Index' shown in histograms). These data support the Matrigel invasion data (Figure 2).
Together, these in vitro data suggest that in breast cancer, aV136 co-operates with HER2 to generate intracellular signals required for invasion and further suggests that blockade of aV136 function could improve HER2-targeted antibody therapy. Note, 264RAD also has some activity against aV138 (29), however MCF-/HER2-18, MCF10A. CAla and BT -474 do not express this integrin hence the actions of the antibody are specifically against aV136 in these cells.
Example 5. Antibody Blockade of 0[136 Improves Trastuzumab Efficacy In Vivo

[0230] To test whether aV136-blockade could improve trastuzumab antibody therapy we tested the effect of 264RAD on the growth of the trastuzumab sensitive BT -474 cell line in vivo. Figure 4A shows 2-week treatment of mice with BT -474 tumors of 100mm3 with 264RAD stopped tumor growth compared to IgG (P<O= 0001 ), whereas trastuzumab (TRA) significantly reduced the growth of tumors by 77.8%
(P<0.0001).
However, the combination of 264RAD and trastuzumab was more effective than SUBSTITUTE SHEET (RULE 26) trastuzumab alone, with a reduction in volume of 94.8% compared to IgG after 14 days treatment (P<0.0001).

[0231] To assess whether aV136-blockade could improve the efficacy of trastuzumab in a trastuzumab-resistant tumor we repeated antibody therapy with the trastuzumab-resistant MCF-7/HER2-18 (HER2-18) cell line in vivo. Tumors were allowed to reach 100mm3 before therapy was commenced. Figure 4B shows that in comparison with IgG controls that progressed rapidly, monotherapy with either or trastuzumab slowed growth by a similar degree (53.9% (P=0.0006) and 52.1%
(P=0.0004) reductions in final volume compared with IgG respectively).
Combination therapy reduced tumor volume to a significantly greater extent than either antibody alone with a further 24.14% reduction in tumor volume compared with trastuzumab alone (P<0.0001) and an overall reduction in tumor volume of 76.2% compared with IgG

(P<0.0001). Representative images of BT -474 and HER2-18 xenografts post-treatment with antibodies are shown in Figure 4C.

[0232] Next we investigated the molecular mechanisms behind this antitumorigenic effect by analyzing protein expression in post-treatment xenografts.
Example 6. Molecular response of breast tumors to 264RAD and trastuzumab therapy.

[0233] Residual tumor tissues from BT-474 and HER2-18 xenografts post 2 week treatment were lysed and analyzed for a variety of signaling molecules from the 2-week treatment regime. Protein expression of the direct targets of each antibody, aV136, HER2 and HER3, were assessed, as well as downstream targets of these pathways (Total (T)-Akt2) and the aV136-associated TGFP signaling pathway (Total (T) and phospho (P)-Smad2). lmmunoblots in Figure 4D (quantified in Figure 4E) show treatment of 3 representative BT -474 xenografts with 264RAD or trastuzumab (TRA) significantly reduced expression of J36; combination therapy almost abolished P6 expression.

Combination therapy also enhanced the reduction of expression observed with trastuzumab alone of HER2, HER3, T-Smad2, PSmad2 and T-Akt2, consistent with the enhanced anti-tumorigenicity observed with the combination treatment.

[0234] HER2-18 xenografts were subject to the same analysis (Figure 4F and G). Again, P6 levels were significantly reduced with the aV136-blocking antibody SUBSTITUTE SHEET (RULE 26) 264RAD and with the combination treatment. Statistically significant reductions in P-HER2, T-HER3, P-HER3, T-Smad2 and T-Akt2 were only observed after combination therapy. T -HER2 levels were increased in HER2-18 tumors treated with trastuzumab, as has been observed previously. We observed that blockade of aVI36 with 264RAD
also increased HER2 expression. However, combined antibody therapy significantly inhibited signaling via HER2 as seen by reduced P-HER2 levels.
Example 7. Antibody Blockade of aV136 Improves Trastuzumab Efficacy and Extends Survival in a Trastuzumab-resistant Model.

[0235] Trastuzumab-resistance poses a significant clinical problem hence we investigated the enhanced anti-tumorigenicity of the combination therapy further in the HER2-18 trastuzumab-resistant model. In initial experiments the effect of the regime on small tumors was assessed. Subcutaneous xenografts were allowed to reach a palpable size (10-20 mm3) before commencing antibody therapy for 6 weeks. 264RAD
reduced growth by over 70% compared with IgG, equivalent to the reduction seen with trastuzumab (both P<0.001) (Figure 5A). More impressively, the combined blockade of aVI36 and HER2 eradicated HER2-18 tumors in all treated mice.

[0236] We next determined whether combination therapy would be as effective on larger xenografts. Tumors were allowed to reach 200mm3 before therapy was commenced. Figure 5B shows that in comparison with IgG controls that progressed rapidly, monotherapy with either 264RAD or trastuzumab again slowed growth by a similar degree (P=0.0019 and P=0.0022 respectively), which was again significantly reduced with combination therapy (P=0.0135 and P=0.0223 respectively).
Combination therapy completely suppressed growth of tumors (P<0.0001 compared to IgG), whose size remained static for 50 days. These mice were allowed to progress until their tumors reached the maximum size permissible (according to Home Office regulations) at which point they were killed. Figure 5C shows that compared with IgG, monotherapy with 264RAD or trastuzumab significantly increased survival (P=0.0007 and P=0.018, respectively), combination therapy was even more effective (P<0.0001). In fact, combination therapy was significantly better than monotherapy (P=0.0039 and P=0.0393 compared with 264RAD and trastuzumab respectively). Thus, 264RAD-blockade of aVI36 suppressed breast cancer growth and enhanced the therapeutic abilities of trastuzumab in both trastuzumab-sensitive and -resistant breast cancer xenografts.

SUBSTITUTE SHEET (RULE 26) Example 8. Molecular response of breast tumors to long-term 264RAD and trastuzumab therapy.

[0237] In order to confirm whether monotherapy was operating via similar molecular mechanisms to the combination therapy, we harvested and lysed tumor tissues after 6 weeks treatment (from Figure 5A) and immunoblotted for the same panel of proteins. As the combination treated xenografts were eradicated early on in this study no analysis of the combination therapy could be performed. Figures 5D and E show and trastuzumab monotherapy over 6 weeks significantly reduces expression of protein, T-HER2, P-HER2, T-HER3, P-HER3, and T-Akt2, similar to the response of combination therapy for 2 weeks (Figures 4D-G).

[0238] Suppression of TGFP signaling, as measured by reduction in T-Smad2 and P-Smad2, occurred in the (trastuzumab-sensitive) BT -474 cells after 2 weeks monotherapy with either 264RAD or trastuzumab, and this reduction was further reduced by combination therapy (Figure 4D). In contrast, there was limited or no change in T-Smad2 or P-Smad2 after 2-week antibody therapy of HER2-18. However, after 6 weeks monotherapy T-Smad2 and PSmad2 levels were significantly reduced in HER2-18 tumors (Figure 5D and E).

[0239] Supporting these data, immunohistochemical analysis of P6 expression in HER2-18 xenografts (Figure 5F) also showed a reduction in P6 expression with monotherapy after 6 weeks, compared to 2 weeks combination therapy where P6 expression was almost eradicated.

[0240] Furthermore, this was supported by Matrigel invasion assays in HER2-18, CAla and BT-474 cells, where cells treated with siRNA to TGF(3RII or antibodies to TGFP (antibody data not shown as results similar) failed to reduce invasion and 264RAD
was able to inhibit invasion, in the presence and absence of TGFP, to a similar degree (Figure 8).
Example 9. Discussion

[0241] This study shows conclusively that 1) up regulation of integrin avP6 in breast cancer is a prognostic factor predicting a poor prognosis for the patient that is linked with development of distant metastases (P=0.03), 2) co-up regulation of avP6 and HER2 identifies one of the worse prognostic sub-groups of breast cancer identified to date and 3) the biological explanation for these clinical observations is that avP6 and SUBSTITUTE SHEET (RULE 26) HER2 co-operate, the integrin avI36 mediating the invasive behavior of HER2-promoted cancer. Thus, our data support the proposal that testing of biopsies for avI36 expression should become a routine immunopathological procedure to stratify women with breast cancer into this new 'very high' risk avI36-positive/HER2+ subgroup. The value of this stratification is that our study also suggests a promising therapeutic strategy for this very high-risk subgroup.

[0242] Since its introduction in 1988 the anti-HER2 antibody trastuzumab has been the first line of therapy for women with HER2+ breast cancer, either as an adjuvant therapy for early stage breast cancer or in combination with chemotherapy for metastatic breast cancer (5,30). Thus, in 2012, when over 225,000 women developed breast cancer in the USA, 20-25% would have had HER2 overexpression (NII-1 statistics) and likely to have received trastuzumab therapy. However, 70% of these women will develop, or have a pre-existing resistance, to trastuzumab (7), which means up to 39,375 American women will develop HER2+ breast cancers for which no specific therapies exist. Our data shows that over 40% of these women with trastuzumab-resistant disease are also likely to express high levels of avI36. We suggest that antibody targeting of avI36 in these women may offer a therapeutic option and our pre-clinical studies support this proposal. Our data show that in both trastuzumab-sensitive and trastuzumab-resistant HER2-overexpressing human breast cancer xenografts, simultaneous antibody targeting of avI36 (with 264RAD) and HER2 (with trastuzumab) significantly improves the therapeutic effect of trastuzumab alone and significantly increases survival time. There is a pressing need to achieve such responses clinically.

[0243] The molecular mechanisms of how the antibody-blockade can suppress, or even reduce, breast cancer growth involves, in part, the changing of the tumor phenotype to a lower risk sub-type. Thus, in antibody treated tumors there is consistent down-regulation of expression of avI36, HER2 and HER3, three receptors whose up regulation promote breast cancer, reduce survival and therefore drive metastasis. Even monotherapy targeting either avI36 or HER2 was able to suppress avI36 expression, further showing that these two molecules are co-regulated in breast cancer.
Down regulation of HER2 was achieved by two weeks of single antibody therapy in the trastuzumab-sensitive line BT -474, but not the trastuzumab-resistant line HER2-18.
However, 6 weeks monotherapy eliminated expression of avI36 HER2 and HER3 in HER2-18 trastuzumab-resistant tumors.
SUBSTITUTE SHEET (RULE 26)

[0244] The loss of avI36 and/or HER2, after antibody-targeting of avI36 or HER2, in either BT-474 or HER2-18 tumor models, significantly slowed tumor growth, but did not stop or reduce tumor growth in the same way that combined avI36/HER2 targeting did. Thus we looked at signaling pathways implicated in avI36 and behaviour.

[0245] Studies have shown that trastuzumab mediates anti-proliferative effects in HER2+ cells by facilitating HER2 degradation (31) and downregulation of P13-K/Akt signaling (32), data consistent with those observed here in vivo, not only with trastuzumab blockade of HER2, but also with aVI36-blockade using 264RAD. We determined that our cell lines expressed Aktl and Akt2 but not Akt3 (data not shown).
Moreover, in vitro, siRNA down regulation of Akt2, but not Aktl suppressed invasion of BT-474, HER2-18 and CAla cell lines (Figure 9). Thus we analyzed our antibody treated tumors for Akt2 protein and showed that combination therapy for 2 weeks significantly reduced Akt2 expression, whereas monotherapy had little effect. Thus, loss of Akt2, the Akt isoform essential for invasion in 3/3 breast carcinoma cell lines, correlates with the improved in vivo efficacy of combined avI36 and HER2 targeting, compared with monotherapy.

[0246] We also examined TGFI3 signaling since avI36 can activate latent TGFI3 (16). Moreover, activated TGFI3 promotes HER2 tumorigenicity by increasing migration, invasion and metastasis (1 0,11, 12,33). Again, only combination therapy significantly reduced total (T) and activated (P)-Smad2 in BT -474 tumors, whereas monotherapy was not significantly effective. In contrast, in the trastuzumab-resistant tumors, the reduction in TGFI3 signaling was moderate, or only a marginal significant reduction in T-Smad2 was observed after combination therapy. Thus, after 2 weeks antibody therapy, down regulation of Akt2, rather than down-regulation of TGFP signaling, correlates more strongly with the enhanced tumor suppression seen with combination therapy.
However this does not negate the likelihood that loss of TGFI3 signaling, due to antibody-blockade of avI36 contributes to tumor therapy and overall survival seen after 6 weeks therapy.

[0247] In summary, we suggest that examining breast cancers for avI36 expression should become standard practice as high expression of avI36 identifies women with significantly more hazardous types of disease. This is especially true for the 40% of women with HER2/ avI36 double-positive cancers who represent one of the worse prognostic breast cancer groups identified to date. Routine determination of avI36 SUBSTITUTE SHEET (RULE 26) expression on breast cancers would stratify women into higher-risk categories requiring therapeutic intervention. In addition, our data also show that antibody blockade of avI36 could offer an effective additional therapy for such women, possibly even those with trastuzumab-resistant disease. The fact that human (264RAD (29)) and humanized (STX-100 (36)) avI36-blocking antibodies are being developed for human use, shows avI36 targeted therapy of breast cancer is feasible and should be a major consideration for the near future.
Example 10. aVI36 Binding Agents: Immunization and Titering Immunization

[0248] Immunizations were conducted using soluble aVI36 and cell-bound aVI36 (CHO transfectants expressing human aVI36 at the cell surface), respectively.
For the generation of CHO transfectants, human full length aVI36 cDNA was inserted into the pcDNA 3 expression vector. CHO cells were transiently transfected via electroporation.
Expression of human aVI36 on the cell surface at the level suitable for immunogen purpose was confirmed by Fluorescene-Activated Cell Sorter (FACS) analysis.
Ten [tg/mouse of soluble protein for Campaign 1, and 3 x 106 cells/mouse of transfected CHO
cells for Campaign 2, were used for initial immunization in XenoMouseTm according to the methods disclosed in U.S. Patent Application Serial No. 08/759,620, filed December 3, 1996 and International Patent Application Nos. WO 98/24893, published June 11, 1998 and WO 00/76310, published December 21, 2000, the disclosures of which are hereby incorporated by reference. Following the initial immunization, thirteen subsequent boost immunizations of five lug/mouse were administered for groups one and two (soluble antigen), and nine subsequent boost immunizations of 1.5 x 106 cells/mouse were administered for groups three and four (cell-bound antigen). The immunization programs are summarized in Table 2.
Table 2: Summary of Immunization Programs Campaign Group Immunogen Strain No of Immunization mice routes 1 1 Soluble aVI36 XMG2/k 10 IP, Tail, BIP, twice/wk, x 6wks 1 2 Soluble aVI36 XMG1/k1 10 IP, Tail, BIP, twice/wk, x 6wks SUBSTITUTE SHEET (RULE 26) Campaign Group Immunogen Strain No of Immunization mice routes 2 3 Cell-bound aVI36 XMG2/k 10 IP, Tail, BIP, (CHO twice/wk, x transfectants) 6wks 2 4 Cell-bound aVI36 XMG1/k1 10 IP, Tail, BIP, (CHO twice/wk, x transfectants) 6wks Selection of Animals for Harvest by Titer

[0249] Titers of the antibody against human aVI36 were tested by ELISA assay for mice immunized with soluble antigen. Titers of the antibody for mice immunized with native (cell-bound) antigen were tested by FACS. The ELISA and FACS analyses showed that there were some mice which appeared to be specific for aVI36.
Therefore, at the end of the immunization program, twenty mice were selected for harvest, and lymphocytes were isolated from the spleens and lymph nodes of the immunized mice, as described in the next example.
Example 11. Recovery of Lymphocytes and B-cell Isolations

[0250] Immunized mice were sacrificed by cervical dislocation, and the draining lymph nodes harvested and pooled from each cohort. The lymphoid cells were dissociated by grinding in DMEM to release the cells from the tissues and the cells were suspended in DMEM. B cells were enriched by negative selection in IgM and positive selection on IgG. The cells were cultured to allow B cell expansion and differentiation into antibody-secreting plasma cells.

[0251] Antibody-secreting plasma cells were grown as routine in the selective medium. Exhaustive supernatants collected from the cells that potentially produce anti-human aVI36 antibodies were subjected to subsequent screening assays as detailed in the examples below.
Example 12. Binding to Cell-bound aVI36

[0252] The binding of secreted antibodies to aVI36 was assessed. Binding to cell-bound aVI36 was assessed using an FMAT macroconfocal scanner, and binding to soluble aVI36 was analyzed by ELISA, as described below.

SUBSTITUTE SHEET (RULE 26)

[0253] Supernatants collected from harvested cells were tested to assess the binding of secreted antibodies to HEK 293 cells stably overexpressing aVI36. A
parental 293F cell line was used as a negative control. Cells in Freestyle media (Invitrogen) were seeded into 384-well FMAT plates in a volume of 50 pilwell at a density of cells/well for the stable transfectants, and at a density of 22,500 cells/well for the parental cells, and cells were incubated overnight at 37 C. Then, 10 pilwell of supernatant was added, and plates were incubated for approximately one hour at 4 C, after which 10 pilwell of anti-human IgG-Cy5 secondary antibody was added at a concentration of 2.8 lug/m1 (400ng/m1 final concentration). Plates were then incubated for one hour at 4 C, and fluorescence was read using an FMAT macroconfocal scanner (Applied Biosystems).
FMAT results for 11 antibodies are summarized in Table 3.

[0254] Additionally, antibody binding to soluble aVI36 was analyzed by ELISA.
Costar medium binding 96-well plates (Costar catalog #3368) were coated by incubating overnight at 4 C with aVI36 at a concentration of 5 lug/m1 in TBS/1mM MgC12 buffer for a total volume of 50 p.L/well. Plates were then washed with TBS/1mM MgC12 buffer, and blocked with 250 [IL of 1X PBS/1% milk for thirty minutes at room temperature.
Ten [t.L
of supernatant was then added to 40 [IL TBS/1mM MgC12/1% milk and incubated for one hour at room temperature. Plates were washed and then incubated with goat-anti-human IgG Fc-peroxidase at 0.400ng/m1 in TBS/1mM MgC12/1% milk, and incubated for one hour at room temperature. Plates were washed and then developed with 1-Step TMB
substrate. The ELISA results for one of the antibodies are shown in Table 3.
Table 3: Binding of Supernatants to Cell-Bound and Soluble aVI36 ELISA
mAb FMAT Data data Count FL1 FL1X Count OD
sc 049 185 4377.73 809880 ND
sc 058 ND ND ND 1.79 sc 188 127 628.04 79761 ND
sc 097 98 1237.18 121243 ND
sc 277 28 382.31 10704 ND
sc 133 82 709.82 58205 ND
sc 161 23 725.21 16679 ND
sc 254 174 9179.65 1597259 ND
sc 264 63 734.29 46260 ND
sc 298 102 2137.94 218069 ND
sc 374 174 4549.65 791639 ND
sc 320 141 3014.63 425062 ND

SUBSTITUTE SHEET (RULE 26) ELISA
mAb FMAT Data data Count FL1 FL1XCount OD
Negative Control (Blank): 0 0 0 0.21 Positive Control (2077z - 1 ug/mL): 67 659.49 44185 6.00 Example 13. Inhibition of Cell Adhesion

[0255] In order to determine the relative potency of the different antibody-containing supernatants, the antibodies were assessed for their ability to inhibit TGFPLAP-mediated adhesion of aVI36-positive HT29 cells. Plates were coated overnight with 10 g/m1TGFPLAP, and pre-blocked with 3% BSA/PBS for 1 hour prior to the assay. Cells were then pelleted and washed twice in HBBS, after which the cells were then resuspended in HBSS at appropriate concentrations. The cells were incubated in the presence of appropriate antibodies at 4 C for 30 minutes in a V-bottom plate.
The antigen coating solution was removed and the plates were blocked with 1000_, of 3% BSA
for one hour at room temperature. Plates were washed twice with PBS or HBSS, and the cell-antibody mixtures were transferred to the coated plate and the plate was incubated at 37 C
for 30 minutes. The cells on the coated plates were then washed four times in warm HBSS, and the cells were thereafter frozen at -80 C for one hour. The cells were allowed to thaw at room temperature for one hour, and then 1000_, of CyQuant dye/lysis buffer (Molecular Probes) was added to each well according to the manufacturer's instructions.
Fluorescence was read at an excitation wavelength of 485 nm and an emission wavelength of 530 nm. The results for twelve antibodies are summarized in Table 4.
Those antibodies shown ranged in potency from 62% inhibition to over 100%
inhibition, relative to coated and uncoated control wells on the plate which were used to represent the maximum and minimum adhesion values that could be obtained in the assay.
Table 4: Adhesion Assay Assay 2 Average Antibody Assay 1%
%

ID Inhibition Inhi %
bition Inhibition sc 049 80% 98% 89%
sc 058 77% 46% 62%
sc 097 96% 106% 101%
sc 133 99% 106% 103%
sc 161 98% 106% 102%
sc 188 99% 103% 101%
SUBSTITUTE SHEET (RULE 26) Assay 2 Average Antibody Assay 1%
%

ID Inhibition Inhi %
bition Inhibition sc 254 98% 106% 102%
sc 264 98% 100% 99%
sc 277 98% 101% 100%
sc 298 98% 102% 100%
sc 320 97% 97% 97%
sc 374 118% 89% 104%
Example 14. Cross-reactivity to Macaque 0[136 and Human aV

[0256] Cross-reactivity of the antibody-containing supernatants to macaque aVP6 was tested on the supernatants using FACS analysis on HEK-293 cells transiently transfected with cynomolgus aV and cynomolgus P6.

[0257] Cross-reactivity to human aV was also tested. For this assay, cross-reactivity was tested on the supernatants using FACS analysis on parental A375M cells, which express aVP3 and aVP5, but not aVP6. This screen was designed to show that the antibodies were specifically recognizing either the P6 chain or the P6 chain in combination with aV. The human aV assay was run at the same time as the macaque aVP6 cross-reactivity screen.

[0258] The assays were performed as follows. A375M cells that were approximately 75% confluent were labeled with CFSE intracellular dye by dissociating and then pelleting cells (equivalent to 250,000 to 300,000 cells per well) in a falcon tube, then resuspending in 0.125 M CFSE in FACS buffer to a final volume of 1000_, for every 250,000 cells, and then by incubating at 37 C for five minutes. The cells were then pelleted, the supernatant discarded, and resuspended in FACS buffer and incubated for 30 minutes at 37 C. Cells were then washed twice with FACS buffer and resuspended in a final volume of 1000_, FACS buffer per well.

[0259] HEK-293 cells were transiently transfected with cynomolgus aV and cynomolgus P6. After 48 hours, the cells were collected and resuspended in FACS buffer to reach a final concentration of approximately 50,000 cells in 100 L.

[0260] Approximately 100,000 cells total, comprising a 50:50 mix of CFSE-labeled A375M cells and transfected 293 cells, were used in each reaction as follows.
1000_, of CFSE-labeled A375M cells and 1000_, of 293 cells were dispensed into a V-bottom plate. The cells in the plate were pelleted at 1500 rpm for 3 minutes, and then SUBSTITUTE SHEET (RULE 26) resuspended in 100 [t.L FACS buffer. The pelleting step was repeated, and the FACS
buffer supernatant was removed. The harvested antibody-containing supernatants, or control primary antibodies were added in a volume of 50 [t.L and the cells were resuspended. Primary antibody controls were murine aVI36 (Cat#MAB2077z, Chemicon) and an anti-aV recombinant. The plate was incubated on ice for 45 minutes, after which 100 [t.L FACS buffer was added to dilute the primary antibody. The cells were then pelleted by centrifuging at 1500 rpm for 3 minutes, and the pellet was resuspended in 100 [t.L FACS buffer. The pelleting step was repeated, and the FACS buffer supernatant was removed. Cells were then resuspended in the appropriate secondary antibody (5 [tg/m1) with 7AAD dye (10 gin* and stained on ice for 7 minutes. Then 150 [t.L of FACS
buffer was added and the cells were pelleted at 1500 rpm for 3 minutes, after which the cells were washed in 100 [t.L FACS buffer, pelleted, and then resuspended in 250 [t.L
buffer and added to FACS tubes. Samples were analyzed on a high throughput FACS
machine and analyzed using Cell Quest Pro software.

[0261] The results for twelve antibodies are summarized in Table 5, and demonstrate that the antibodies shown were able to specifically bind to macaque aVI36 but were not able to non-specifically bind human aV on the parental A375M
cells.
Table 5. Cross-Reactivity to Macaque aVI36 and Human aV
Mac Antibody AVB6 % Mac AVB6 A375M %A375M
Cells ID Cells GeoMeanGeoMean Shifted Shifted sc 049 23% 30.19 20% 1.74 sc 058 25% 22.77 18% 1.78 sc 097 35% 37.04 24% 1.84 sc 133 32% 35.22 24% 1.79 sc 161 14% 32.98 11% 16.68 sc 188 18% 23.9 13% 1.65 sc 254 59% 78.49 55% 2.31 sc 264 55% 66.38 46% 2.35 sc 277 35% 33.35 23% 1.86 sc 298 53% 63.08 45% 2.14 sc 320 19% 33.45 15% 23.18 sc 374 51% 61.79 39% 2.14 Human IgG
Isotype 1% (day 1) 9.54 (day 1) 5% (day 1) 1.66 (day 1) Control 0% (day 2) 7.39 (day 2) 1% (day 2) 7.23 (day 2) Mouse 1% (day 1) 8.85 (day 1) 4% (day 1) 1.67 (day 1) SUBSTITUTE SHEET (RULE 26) Mac Antibody AVB6 % Mac AVB6 A375M %A375M
Cells ID Cells GeoMeanGeoMean Shifted Shifted IgG2 with 0% (day 2) 11.21 (day 2) 3% (day 2) 11.16 (day 2) Murine Secondary Antibody Positive 42% (day Control 1) 2077z 11% (day 55.52 (day 1) 30% (day 1) 2.03 (day 1) (lug/nil) 2) 28.11 (day 2) 5% (day 2) 15.36 (day 2) Example 15. aVI36-specific Hemolytic Plaque Assay

[0262] Antibody-secreting plasma cells were selected from each harvest for the production of recombinant antibodies. Here, a fluorescent plaque assay was used to identify single plasma cells expressing antibodies against aVI36. Then, the single cells were subjected to reverse transcription and polymerase chain reaction to rescue and amplify the variable heavy and variable light chains that encoded the initial antibody specificity, as described in the next example. The preparation of a number of specialized reagents and materials needed to conduct the aVI36-specific hemolytic plaque assay are described below.

[0263] Biotinylation of Sheep red blood cells (SRBC). SRBC were stored in RPMI media as a 25% stock. A 250 i.il SRBC packed-cell pellet was obtained by aliquoting 1.0mL of the stock into a 15-mL falcon tube, spinning down the cells and removing the supernatant. The cell pellet was then re-suspended in 4.75mL PBS
at pH 8.6 in a 50mL tube. In a separate 50mL tube, 2.5 mg of Sulfo-NHS biotin was added to 45mL
of PBS at pH 8.6. Once the biotin had completely dissolved, 5mL of SRBCs was added and the tube was rotated at room temperature for 1 hour. The SRBCs were centrifuged at 3000g for 5 minutes. The supernatant was drawn off and 25mL PBS at pH 7.4 was added as a wash. The wash cycle was repeated 3 times, then 4.75mL immune cell media (RPMI
1640 with 10% FCS) was added to the 250 i.il biotinylated-SRBC (B-SRBC) pellet to gently re-suspend the B-SRBC (5% B-SRBC stock). The stock was stored at 4 C
until needed.

[0264] Streptavidin (SA) coating of B-SRBC. One mL of the 5% B-SRBC stock was transferred into to a fresh eppendorf tube. The B-SRBC cells were pelleted with a SUBSTITUTE SHEET (RULE 26) pulse spin at 8000 rpm (6800 rcf) in a microfuge. The supernatant was then drawn off, the pellet was re-suspended in 1.0mL PBS at pH 7.4, and the centrifugation was repeated.
The wash cycle was repeated 2 times, then the B-SRBC pellet was resuspended in 1.0 mL
of PBS at pH 7.4 to give a final concentration of 5% (v/v). 10 i.il of a 10mg/mL
Streptavidin (CalBiochem, San Diego, CA) stock solution was added. The tube was mixed and rotated at RT for 20 minutes. The washing steps were repeated and the SA-SRBC were re-suspended in 1 mL PBS pH 7.4 (5% (v/v)).

[0265] Human aVI36 coating of SA-SRBC. Soluble antigen (lacking the transmembrane domain) was used for coating the SRBC. Both chains were used because aVI36 is only presented on the cell surface as a dimer. The SA-SRBC were coated with the biotinylated-aVI36 at 50pg/mL, mixed and rotated at room temperature for minutes. The SRBC were washed twice with 1.0 mL of PBS at pH 7.4 as above. The Ag-coated SRBC were re-suspended in RPMI (+10%FCS) to a final concentration of 5%

(v/v).

[0266] Determination of the quality of aVI36-SRBC by immunofluorescence (IF).
i.il of 5% SA-SRBC and 10 i.il of 5% Ag-coated SRBC were each added to separate fresh 1.5mL eppendorf tube containing 40 i.il of PBS. Human anti-aVI36 antibodies were added to each sample of SRBCs at 50 [tg/mL. The tubes were rotated at room temperature for 25 min, and the cells were then washed three times with 100 i.il of PBS.
The cells were re-suspended in 50 i.il of PBS and incubated with 2 [tg/mL Gt-anti Human IgG
Fc antibody conjugated to the photostable fluorescent dye A1exa488 (Molecular Probes, Eugene, OR). The tubes were rotated at room temperature for 25 min, followed by washing with 100 i.il PBS and re-suspension in 10 i.il PBS. 10 i.il of the stained cells were spotted onto a clean glass microscope slide, covered with a glass coverslip, observed under fluorescent light, and scored on an arbitrary scale of 0-4 to assess the quality of the isolated cells.

[0267] Preparation of plasma cells. The contents of a single B cell culture well previously identified as neutralizing for aVI36 activity (therefore containing a B cell clone secreting the immunoglobulin of interest), was harvested. The B cell culture present in the well was recovered by addition of RPMI +10% FCS at 37 C. The cells were re-suspended by pipetting and then transferred to a fresh 1.5mL eppendorf tube (final volume approximately 500-700 IA The cells were centrifuged in a microfuge at 1500 rpm (240 rcf) for 2 minutes at room temperature, then the tube was rotated 180 degrees and SUBSTITUTE SHEET (RULE 26) centrifuged again for 2 minutes at 1500 rpm. The freeze media was drawn off and the immune cells were resuspended in 100 i.il RPMI (10% FCS), then centrifuged.
This washing with RPMI (10% FCS) was repeated and the cells re-suspended in 60 i.il RPMI
(FCS) and stored on ice until ready to use.

[0268] Performance of the Hemolytic Plaque Assay. To the 60 i.il sample of immune cells was added 60 i.il each of aVI36-coated SRBC (5% v/v stock), 4x guinea pig complement (Sigma, Oakville, ON) stock prepared in RPMI (FCS), and 4x enhancing sera stock (1:900 in RPMI (FCS)). The mixture (3-50) was spotted onto plastic lids from 100 mm Falcon tissue culture plates and the spots were covered with undiluted paraffin oil. The slides were incubated at 37 C for a minimum of 45 minutes.

[0269] Analysis of Plaque assay results. The coating of the sheep red blood cells with the catalytic domain of human aVI36 was successful. These Ag-coated red blood cells were then used to identify antigen-specific plasma cells from the wells shown below in Table 6. These cells were then isolated by micromanipulation. After micromanipulation to rescue the antigen-specific plasma cells, the genes encoding the variable region genes were rescued by RT-PCR on a single plasma cell, as described further in the next example.
Table 6. Plaque Assay Results Parent Plate Plaque Assay ID
Plate Row Column Assay Single Cells 68 B 10 Fluorescent 45-57 296 D 10 Fluorescent 58-59 318 F 1 Hemolytic 60-62 612 G 1 Fluorescent 187-189 752 D 12 Fluorescent 95-100 762 D 8 Fluorescent 277-286 766 B 5 Fluorescent 132-143, 147-150 827 E 12 Fluorescent 159-170 659 F 11 Fluorescent 252-263 761 H 3 Fluorescent 264-276 765 A 8 Fluorescent 287-298 652 D 2 Fluorescent 374-379, 392-397 806 A 6 Fluorescent 312-321 SUBSTITUTE SHEET (RULE 26) Example 16. Recombinant Protein Isolation

[0270] After isolation of the desired single plasma cells, mRNA was extracted and reverse transcriptase PCR was conducted to generate cDNA encoding the variable heavy and light chains of the antibody secreted by each cell. The human variable heavy chain cDNA was digested with restriction enzymes that were added during the PCR and the products of this reaction were cloned into an IgG2 expression vector with compatible overhangs for cloning. This vector was generated by cloning the constant domain of human IgG2 into the multiple cloning site of pcDNA3.1+/Hygro (Invitrogen, Burlington, Ontario, Canada). The human variable light chain cDNA was digested with restriction enzymes that were added during the PCR reaction and the products of this reaction were cloned into an IgKappa or IgLamda expression vector with compatible overhangs for cloning. This vector was generated by cloning the constant domain of human IgK
or IgL
into the multiple cloning site of pcDNA3.1+/Neo (Invitrogen).

[0271] The heavy chain and the light chain expression vectors were then co-transfected using lipofectamine into a 60 mm dish of 70% confluent human embryonal kidney (HEK) 293 cells. The transfected cells secreted a recombinant antibody with the identical specificity as the original plasma cell for 24 to 72 hours. The supernatant (3 mL) was harvested from the HEK 293 cells and the secretion of an intact antibody was demonstrated with a sandwich ELISA to specifically detect human IgG.
Specificity was confirmed through binding of the recombinant antibody to aVI36 using ELISA.
The rescued clones secreting antibody that could bind to the target antigen are summarized in Table 7.
Table 7. Secretion and Binding Data for the Recombinant Antibodies Parent Plate ID
Antibody Plate Row Column ID

SUBSTITUTE SHEET (RULE 26) Example 17. Purification of Recombinant Antibodies

[0272] For larger scale production of the anti-aVI36 antibodies, heavy and light chain expression vectors (2.5 i_tg of each chain/dish) were lipofected into ten 100 mm dishes that were 70% confluent with HEK 293 cells. The transfected cells were incubated at 37 C for 4 days, the supernatant (6 mL) was harvested and replaced with 6 mL of fresh media. At day 7, the supernatant was removed and pooled with the initial harvest (120 mL total from 10 plates). The antibodies were purified from the supernatant using Protein-A Sepharose (Amersham Biosciences, Piscataway, NJ) affinity chromatography (1 mL). The antibodies were eluted from the Protein-A column with 500 [t.L of 0.1 M
Glycine pH 2.5. The eluate was dialyzed in PBS pH 7.4 and filter sterilized.
The antibodies were analyzed by non-reducing SDS-PAGE to assess purity and yield.
Protein concentration was determined by determining the optical density at 280 nm.
Example 18. Structural Analysis of 0[136 Antibodies

[0273] The variable heavy chains and the variable light chains of the antibodies were sequenced to determine their DNA sequences. The complete sequence information for the anti-aVI36 antibodies is provided in the sequence listing with nucleotide and amino acid sequences for each gamma and kappa/lambda chain combination. The variable heavy sequences were analyzed to determine the VH family, the D-region sequence and the J-region sequence. The sequences were then translated to determine the primary amino acid sequence and compared to the germline VH, D and J-region sequences to assess somatic hypermutations.

[0274] Table 8 is a table comparing the antibody heavy chain regions to their cognate germ line heavy chain region. Table 9 is a table comparing the antibody kappa or lambda light chain regions to their cognate germ line light chain region.

[0275] The variable (V) regions of immunoglobulin chains are encoded by multiple germ line DNA segments, which are joined into functional variable regions (VHDJH or VKJK) during B-cell ontogeny. The molecular and genetic diversity of the SUBSTITUTE SHEET (RULE 26) antibody response to aVI36 was studied in detail. These assays revealed several points specific to anti-aVI36 antibodies.

[0276] According the sequencing data, the primary structure of the heavy chains of sc 298 and sc 374 are similar, but not identical. sc 254 is structurally different from the other two. It should also be appreciated that where a particular antibody differs from its respective germline sequence at the amino acid level, the antibody sequence can be mutated back to the germline sequence. Such corrective mutations can occur at one, two, three or more positions, or a combination of any of the mutated positions, using standard molecular biological techniques. By way of non-limiting example, Table 9 shows that the light chain sequence of sc 298 (SEQ ID NO.: 40) differs from the corresponding germline sequence (SEQ ID NO. :68) by a Val to Ala mutation (mutation 1) in the FR1 region, via a Leu to Ala mutation (mutation 2) in the CDR1 region and an Asn to Ser in the region. Thus, the amino acid or nucleotide sequence encoding the light chain of sc 298 can be modified to change mutation 1 to yield the germline sequence at the site of mutation 1. Further, the amino acid or nucleotide sequence encoding the light chain of mAb sc 298 can be modified to change mutation 2 to yield the germline sequence at the site of mutation 2. Still further, the amino acid or nucleotide sequence encoding the light chain of mAb sc 298 can be modified to change mutation 3 to yield the germline sequence at the site of mutation 3. Still further again, the amino acid or nucleotide sequence encoding the light chain of sc 298 can be modified to change mutation 1, mutation 2 and mutation 3 to yield the germline sequence at the sites of mutations 1, 2 and 3. Still further again, the amino acid or nucleotide sequence encoding the light chain of sc 298 can be modified to change any combination of mutation 1, mutation 2 and mutation 3. In another example, heavy chain of sc 264 (SEQ ID NO: 30) differs from its germline (SEQ ID NO: 55) at position 61. Thus the amino acid or nucleotide sequence encoding the heavy chain of sc 264 can be modified from a N to Y to yield the germline sequence. Tables 10-13 below illustrate the position of such variations from the germline for sc 133, sc 188 and sc 264. Each row represents a unique combination of germline and non-germline residues at the position indicated by bold type. Particular examples of an antibody sequence that can be mutated back to the germline sequence include:
sc 133 where the L at amino acid 70 of the heavy chain is mutated back to the germline amino acid of M (referred to herein as sc 133 TMT); sc 133 where the N at amino acid 93 of the light chain is mutated back to the germline amino acid of D (referred to herein as sc 133 SUBSTITUTE SHEET (RULE 26) WDS); and sc 264 where the A at amino acid 84 of the light chain is mutated back to the germline amino acid of D (referred to herein as sc 264 ADY).

[0277] One embodiment includes modifying one or more of the amino acids in the CDR regions, i.e., CDR1, CDR2 and/or CDR3. In one example, the CDR3 of the heavy chain of an antibody described herein is modified. Typically, the amino acid is substituted with an amino acid having a similar side chain (a conservative amino acid substitution) or can be substituted with any appropriate amino acid such as an alanine or a leucine. In one embodiment, the sc 264 CDR3, VATGRGDYHFYAMDV (amino acid residues 100-114 of SEQ ID NO: 30), can be modified at one or more amino acids.
Applicants have already demonstrated that the CDR3 region can be modified without adversely affecting activity, i.e., see sc 264 RAD where the second G in the CDR3 region is substituted for an A. Other modifications within the CDR3 region are also envisaged.
In another embodiment, the sc 133 CDR3 region, RLDV, can be modified at one or more amino acids including substituting the L for an A and/or the V for an A. Means of substituting amino acids are well known in the art and include site-directed mutagenesis.

[0278] Another embodiment includes replacing any structural liabilities in the sequence that might affect the heterogeneity or specificity of binding of the antibodies. In one example, the antibody sc 264 has an RGD sequence in the CDR3 region that might cause cross-reactive binding. Therefore the glycine residue in the RGD can be replaced with an alanine (sc 264 RAD).

SUBSTITUTE SHEET (RULE 26) Table 8. Heavy chain analysis t..) =
Chain SEQ
u, FR3 CDR3 FR4 -a Name NO:
,.tD
t..) cio WVRQ
c' QVQLVQSGA GYTFT APGQG WINPNSG RVTMTRDTSIST
WGQG
49 Germline EVKKPGASV GYYM LEWM GTNYAQ AYMELSRLRSDD RL--TTVT
KVSCKAS H G KFQG TAVYYCAR
VSS
cf) c QVQLVQSGA GYTFT WVRQWINPKSG
RVTLTRDTSTST WGQG
co JH6 APGQG
cf) sc 133 14 VH1-2 5-12 EVKKPGASV GYYM LEWM DTNYAQ
AYMELSRLRSDD RLDV TTVT
¨I B
KVSCKAS H KFQG TAVYYCAR VSS
G
c P
H

m EVQLVESGG GFTFS WVRQ SISSSSSY
RFTISRDNAKNS WGQG
cf) VQLERY
50 Germline GLVKPGGSL SYSM APGKG IYYADSV LYLQMNSLRAE
YYYYGM TTVT
, m RLSCAAS N LEWVS KG
DTAVYYCAR VSS
m H
DV

RFTISRDNAKNS DPVPLER WGQG
c sc 320 42 D1-1 GLVKPGGSL NYIM APGKG YYADSV
LYLQMNSLRAE RDYYYG TTVT "
1¨ 21 B
m RLSCAAS H LEWVS KG
DTAVYYCAR MDV VSS
1\) cn EVQLLESGG GFTFS WVRQ AISGSGG
RFTISRDNSKNTL - WGQG
51 Germline GLVQPGGSL SYAM APGKG STYYADS YLQMNSLRAED VDTAMV TTVT
RLSCAAS S LEWVS VKG
TAVYYCAK YYGMDV VSS

RFTISRDNSKNTL GVDTAM WGQG
sc 58 6 D5-5 GLVQPGGSL SYVM APGKG STYYADS
YLQMNSLRAED VTYGMD TTVT od n RLSCAAS S LEWVS VKG
TAVYYCAK V VSS
WVRQ
m od QVQLVESGG GFTFS
VIVVYDGS RFTISRDNSKNTL -IAAR-- WGQG t..) APGKG
'=' 52 Germline GVVQPGRSL SYGM NKYYAD YLQMNSLRAED
YYYYYG TTVT
4,.
O-RLSCAAS H LEWV SVKG

A
o sc 298 38 VH3- D6-6 JH6 QVQLVESGG GFTFS WVRQ VIVVYGGS RFTISRDNSKNTL DLAARR
WGQG t..) cio Chain SEQ

FR3 CDR3 FR4 t..) =
Name .
NO:
u, -a B GVVQPGRSL SYGM APGKG NKYYAD
YLQMNSLRAED GDYYYY TTVT
RLSCAAS H LEWV SVKG
TAVYYCAR GMDV VSS t..) cee o A
WVRQ

QVQLVESGG GFTFS
VIVVYDGS RFTISRDNSKNTL TEGIAAR WGQG

sc 374 46 D6-6 B LEWV GVVQPGRSL SYGM
NKYYAD YLQMNSLRAED LYYYYG TTVT
cf) 33 RLSCAAS H
SVKG TAVYYCAR MDV VSS
c A
co cf) H QVQLQESGP GGSIS WIRQH YIYYSGS
RVTISVDTSKNQ WGQG
GIAAAG--c 53 Germline GLVKPSQTLS SGGY PGKGL TYYNPSL
FSLKLSSVTAAD
YYYYYG TTVT P
H LTCTVS YWS EWIG KS

m (./1 = g QVQLQESGP GGSIS WIRQH YIYYSGS
RVTISVDTSKNQ YRGPAA WGQG
-J,2 m VH4-m Sc 254 26 D6-13 GLVKPSQTLS SGGY PGKGL TYYNPSL
FSLKLSSVTAAD GRGDFY TTVT c,"

LTCTVS YWS EWIG KS
TAMYYCAR YFGMDV VSS
,I, QVQLQESGP GGSIS WIRQH YIYYSGS RVTISVDTSKNQ ---WGQG
"' c "
r 54 Germline GLVKPSQTLS SGGY PGKGL TYYNPSL
FSLKLSSVTAAD ITIFGVFD TLVT
rrl 1\) LTCTVS YWS EWIG KS
TAVYYCAR Y VSS
cn Sc 49 2 D3-3 B
VFDY GLVKPSQTLS SGDY PGKGL TYYNPSL SLKLTSVTAADT
TLVT

LTCTVA YWS EWIG KS
AVYYCAR VSS
QVQLQESGP GGSIS WIRQH YIYYSGS RVTISVDTSKNQ VAT---WGQG
od 55 Germline GLVKPSQTLS SGGY PGKGL TYYNPSL FSLKLSSVTAAD YYYYYG
TTVT n 1-i LTCTVS YWS EWIG KS
TAVYYCAR MDV VSS m QVQLQESGP GGSIS WIRQH YIYYSGR RVTISVDTSKNQ VATGRG WGQG
od t..) c' Sc 264 30 DYHFYA TTVT
4,.

O-YWS EWIG KS

QVQLQESGP GGSIS WIRQH YIYYSGS RVTISVDTSKNQ ---WGQG
o t..) 56 Germline cee GLVKPSQTLS SGGY PGKGL TYYNPSL FSLKLSSVTAAD LRYYYY TTVT

Chain SEQ

FR3 CDR3 FR4 t..) =
Name .
NO:
u, -a LTCTVS YWS EWIG KS
TAVYYCAR YGMDV VSS
,o t..) QVQLQESGP GGSIS WIRQH YIYYSGS RVTISVDTSKKQ EGPLRGD WGQG

cee, Sc 188 22 D4-23 B GLVKPSQTLS SGVY PGNGL TSYNPSL FSLNLTSVTAAD YYYGLD
TTVT

LTCTVS YWT EWIG KS
TAVYYCAR V VSS
WVRQ
EVQLVQSGA GYSFT IIYPGDSD QVTISADKSISTA WGQG
MPGK
cf) 57 Germline EVKKPGESLK SYWI
TRYSPSF YLQWSSLKASDT SSGYYYA TMVT
c GLEW
co ISCKGS G QG
AMYYCAR FDI VSSA
cf) MG
H
WVRQ
c VHS- JH3 EVQLVQSGA GYSFT MPGK IIYPGDSD
QVILSADKSISTA HDESSGY WGQG p ¨I Sc 97 10 D3-22 EVKKPGESLK SYWI

m 51 B GLEW
YYVFDI ,,' cf) ISCKGS G QG
AMYYCAR VSSA ou' = St MG
?]
m m WVRQ
c,"
¨I EVQLVQSGA GYSFT
IIYPGDSD QVTISADKSISTA WGQG
MPGK
,I, 58 Germline EVKKPGESLK SYWI
GLEW TRYSPSF YLQWSSLKASDT
GMDV TTVT
No c ISCKGS G MG QG AMYYCAR
VSS No 1¨
rrl 1\) WVRQ
EVQLVQSGA GYSFP MPGK IIYPGDSD QVTISADKSISTA HPMEDG WGQG
cn Sc 277 34 VHS- JH6 D3-10 EVKKPGESLK SYWI TRYSPSF YLQWSSLKASDT TTVT

MDV
ISCKGS G MG QG AMYYCAR
VSS
WVRQ
EVQLVQSGA GYSFT
IIYPGDSD QVTISADKSISTA -GIAAAG- WGKG od MPGK
n 59 Germline EVKKPGESLK SYWI GLEW TRYSPSF
YLQWSSLKASDT YYYGMD TTVT
m ISCKGS G MG QG AMYYCAR V VSSA od t..) o WVRQ.6.

EVQLVQSGA GYSFT
IIYPGDSD QVTISADKSISTA HGIAAAG WGQG
VHS-O-MPGK

Sc 161 18 D6-13 EVKKPGESLK SYWI 51 GLEW TRYSPSF
YLQWSSLKASDT FYYYYM TTVT C ' t..) ISCKGS G QG
AMYYCAR DV VSSA cio MG

t..) Table 9. Light chain analysis u, O-.6.
SE
,.tD
t..) oe Chain Q V CDR
=

Name NO Kappa 2 =
(A DIVMTQTPL KSSQSLL WYLQKP EVS GVPDRFSGSGSG
FGQG
c MQSIQ
co 60 Germline SLSVTPGQP HSDGKT GQPPQL NRF TDFTLKISRVEAE
TKVEI
cf) LPWT
H ASISC YLY LIY S DVGVYYC
K
DIVMTQTPL KSSQSLL WYLQKP EVS GVPDRFSGSGSG MQGI FGQG
c P
¨I Sc 254 28 A2 JK1 SLSVTPGQP NSDGKT GQPPQL NRF TDFTLKISRVEAE QLPW TKVEI
NO
m .
cf) ASIFC YLC LIY S
DVGVYYC AF K ' = 22 EIVLTQSPGT WYQQK GAS
GIPDRFSGSGSGT FGQG 5', -Jm RASQSV QQYG N)rn 61 Germline LSLSPGERAT PGQAPR SRA DFTLTISRLEPED TKVEI
SSPWT
.
, LSC LLIY T FAVYYC

c EIVLTQSPGT WYQQK GAS GIPDRFSGSGSGT
QQYG FGQG
RAGQTIS
"
r m sc 188 24 A27 JK1 LSLSPGERAT
SRYLA PGQAPR SRA DFTLTISRLEPED SSPRT TKVEI
1\) LSC PLIY T FAVYYC
K
cn EIVLTQSPGT WYQQK GAS
DIPDRFSGSGSGT QQYG RASQSV FGQG
sc 374 48 A27 JK1 LSLSPGERAT
SSSYLA PGQAPR SRA DFTLTISRLEPED SSPWT TKVEI
LSC LLIY T FAVYYC
K
EIVLTQSPGT WYQQK GAS
GIPDRFSGSGSGT FGQG od RASQSV
QQYG n 62 Germline LSLSPGERAT
SSSYLA PGQAPR SRA DFTLTISRLEPED
TKLEI 1-i SSPYT
LSC LLIY T FAVYYC
K m od t..) EIVLTQSPGT WYQQK GAS
GIPDRFSGSGSGT QQYG FGQG
RASQSV
=
4,.
Sc 49 4 A27 JK2 LSLSPGERAT
SSSYLA PGQAPR SRA DFTLTISRLEPED SSPCS TKLEI
O-LSC LLIY T FAVYYC
K
o 63 Germline EIVLTQSPGT RASQSV WYQQK GAS GIPDRFSGSGSGT QQYG
FGPGT t..) cio SE
C
Chain Q V CDR
t..) FR3 CDR3 J u, Name NO Kappa 2 -a 4,.
,z t..) =
.
oe =
LSLSPGERAT SSSYLA PGQAPR SRA DFTLTISRLEPED SSPFT KVDIK
LSC LLIY T FAVYYC
R
EIVLTQSPDT WYQQK GTS
GIPDRFSGSGSGT FGPGT
RAS QNV
QQCG
sc 161 20 A27 JK3 LSLSPGERAS PGQAPR NRA
DFTLTISRLEPED KVDIK
(A NRNYLV
SLPFT
c LSC LLIY T FAVYYC
R
co (A
H
c P
H

m CII
u, = eze 5;
,J
M
n, M

r H
.

N)' C
n, I¨
rrl NJ

.0 n 1-i m oo t..) =
4,.
'a =
t..) oe SE
C
Chain V
Name ID Lamb J FR1 CDR1 FR2 CDR
FR3 CDR3 J u, -a NO da 4..
,z t..4 =
.
oe =
QSVLTQPPS WYQQLP DNN
GIPDRFSGSKSGT GTWD
SGSSSNI
FGTGT
64 Germline VSAAPGQKV GTAPKL KRP
SATLGITGLQTG SSLSA
GNNYVS
KVTV
TISC LIY S
DEADYYC -YV
(A QSVLTQPPS
SGSSSNI WYQQLP DNN GIPDRFSGSKSGT GTWN
FGTGT
c sc 133 16 V1-19 JL1 VSAAPGQKV GNNYVS GTAPKL KRP SATLGITGLQTG SSLSA
co KVTV
(A TISC LIY S
DEADYYC GYV
H
QSVLTQPPS
SGSSSNI WYQQLP DNN GIPDRFSGSKSGT GTWD FGGG
c 65 Germline VSAAPGQKV GTAPKL KRP
SATLGITGLQTG SSLSA TKLT P
H GNNYVS
,9 m TISC LIY S DEADYYC VV VL
(1l = g QSVLTQPPS
SGSSSNI WYQQLP DNN GIPDRFSGSKSGT GTWD FGGG
0, , m Sc320 44 V1-19 JL2 MSAAPGQK GTAPKL KRP
SATLGITGLQTG SSLSA TKLT "
.
m , H VTISC GNNYVS LIY S
DEADYYC GV VL , .
SYELTQPPSV WYQQK EDS
GIPERFSGSSSGT YSTDS FGGG
c SGDALP
N) r 66 Germline SVSPGQTARI SGQAPV KRP
MATLTISGAQVE SGNH TKLT
m KKYAY
1\) TC LVIY S DEADYYC VV VL
cn SYELTQPPSV WYQQK DDN
GIPERFSGSSSGT YSTDS FGGG
SGDALP
Sc 277 36 V2-7 JL2 SVSPGQTARI SGQAPV KRP MATLTITGAQVE SGHH TKLT
KKYAF
TC LVIY S DEADYYC V VL
SYELTQPPSV WYQQK
GIPERFSGSSSGT YSTDS FGGG
SGDALP
od Sc 97 12 V2-7 JL2 SVSPGQTARI SGQAPV EDIK MATLTISGAQVE SGNH TKLT n KKYAY
TC LVIY RPS DEADYYC
WVF VL m SYELTQPPSV WYQQK EDS
GIPERFSGSSSGT YSTDS FGGG od t..) SGDALP
=
67 Germline SVSPGQTARI SGQAPV KRP
MATLTISGAQVE SGNH TKLT
4,.
KKYAY
O-TC LVIY S DEADYYC VV VL

SYELTQPPSV SGDALP WYQQK DDS GIPERFSGSSSGT YSTDS FGGG
' t..) Sc 58 8 V2-7 JL3 cee SVSPGQTARI KKYAY SGQAPV KRP MATLTISGAQVE SGNH TKLT

TC LVIY S DEADYYC RV VL

SSELTQDPA WYQQK GKN
GIPDRFSGSSSGN NSRDS FGGG t..) QGDSLR
o 68 Germline VSVALGQTV
SYYAS PGQAPV NRP TASLTITGAQAE SGNH TKLT
u, O-RITC LVIY S DEADYYC VV VL
,o SSELTQDPV WYQQK GKN
GIPDRFSGSNSG NSRDS FGGG t..) cee QGDSLR
sc 298 40 V2-13 JL2 VSVALGQTV
SYYLS PGQAPV NRP NTASLTITGAQA SGNH TKLT
RITC LVIY S EDEADYYC L VL
SYELTQPSSV WFQQKP
GIPERFSGSSSGT YSAA FGGG
SGDVLA KDS
cf) 69 Germline SVSPGQTARI
KKYAR GQAPVL
ERPS TVTLTISGAQVE DNNV TKLT
c TC VIY
DEADYYC V VL
co cf) SYELTQPSSV WFHQKP
GIPERFSGSSSGT YSAA FGGG
H SGDVLA KDS
Sc 264 32 V2-19 JL2 SVSPGQTARI GQAPVL TVTLTISGAQVE DNNL TKLT
c TC KKSAR ERPS
P
VIY
DEAAYYC V VL
H

m (./1 = 4 5;
, m , , m .
H
, 1 , , ,i c , , r m NJ
cn oo n 1-i m oo t..) o 4,.
O-o t..) oo Table 10: Exemplary Mutations of sc 133 Heavy Chain (SEQ ID NO: 14) to Germline (SEQ ID NO: 49) at the indicated Residue Number N G M T
N G L I
N G L T
N D M I
N D L I
N D M T
N D L T
K G M I
K G M T
K G L I
K G L T
K D M I
K D L I
K D M T
Table 11: Exemplary Mutations of sc 188 Light Chain (SEQ ID NO: 24) to Germline (SEQ ID NO: 61) at the indicated Residue Number G S V S L
G S V S P
G S V R P
G S V R L
G S V R L
G S V S P
G S I R P
G S I R L
G T V R L
G T V S P
G T V S L
G T I R P
G T I R L
G T I S L
S S V S P
S S V R P
S S V R L
S S V R L

SUBSTITUTE SHEET (RULE 26) S S V S P
S S I R P
S S I R L
S T V R L
S T V S P
S T V S L
S T I R P
S T I R L
S T I S L
Table 12: Exemplary Mutations of sc 188 Heavy Chain (SEQ ID NO: 22) to Germline (SEQ ID NO: 56) at the indicated Residue Number G S K Y N K S
G S K Y N K T
G S K Y N N S
G S K Y N N T
G S K Y K N S
G S K Y K N T
G S K Y K K S
G S K Y K K T
G S K S N K S
G S K S N K T
G S K S N N S
G S K S N N T
G S K S K N S
G S K S K N T
G S K S K K S
G S K S K K T
G S N Y N K S
G S N Y N K T
G S N Y N N S
G S N Y N N T
G S N Y K N S
G S N Y K N T
G S N Y K K S
G S N Y K K T
G S N S N K S
G S N S N K T
G S N S N N S
G S N S N N T
G S N S K N S
G S N S K N T
G S N S K K S

SUBSTITUTE SHEET (RULE 26) G S N S K K T
/ S K Y N K S
/ S K Y N K T
/ S K Y N N S
/ S K Y N N T
/ S K Y K N S
/ S K Y K N T
/ S K Y K K S
/ S K Y K K T
/ S K S N K S
/ S K S N K T
/ S K S N N S
/ S K S N N T
/ S K S K N S
/ S K S K N T
/ S K S K K S
/ S K S K K T
/ S N Y N K S
/ S N Y N K T
/ S N Y N N S
/ S N Y N N T
/ S N Y K N S
/ S N Y K N T
/ S N Y K K S
/ S N Y K K T
/ S N S N K S
/ S N S N K T
/ S N S N N S
/ S N S N N T
/ S N S K N S
/ S N S K N T
/ S N S K K S
/ S N S K K T
G I K Y N K S
G I K Y N K T
G I K Y N N S
G I K Y N N T
G I K Y K N S
G I K Y K N T
G I K Y K K S
G I K Y K K T
G I K S N K S
G I K S N K T
G I K S N N S

SUBSTITUTE SHEET (RULE 26) G I K S N N T
G I K S K N S
G I K S K N T
G I K S K K S
G I K S K K T
G I N Y N K S
G I N Y N K T
G I N Y N N S
G I N Y N N T
G I N Y K N S
G I N Y K N T
G I N Y K K S
G I N Y K K T
G I N S N K S
G I N S N K T
G I N S N N S
G I N S N N T
G I N S K N S
G I N S K N T
G I N S K K S
G I N S K K T
/ I K Y N K S
/ I K Y N K T
/ I K Y N N S
/ I K Y N N T
/ I K Y K N S
/ I K Y K N T
/ I K Y K K S
/ I K Y K K T
/ I K S N K S
/ I K S N K T
/ I K S N N S
/ I K S N N T
/ I K S K N S
/ I K S K N T
/ I K S K K S
/ I K S K K T
/ I N Y N K S
/ I N Y N K T
/ I N Y N N S
/ I N Y N N T
/ I N Y K N S
/ I N Y K N T
/ I N Y K K S
SUBSTITUTE SHEET (RULE 26) / I N Y K K T
/ I N S N K S
/ I N S N K T
/ I N S N N S
/ I N S N N T
/ I N S K N S
/ I N S K N T
/ I N S K K S
/ I N S K K T
Table 13: Exemplary Mutations of sc 264 Light Chain (SEQ ID NO: 32) to Germline (SEQ ID NO: 69) at the indicated Residue Number Y H A
Y H D
Y Q A
S H D
S Q D
S Q A
Example 19. Potency Determination of aV136 Antibodies

[0279] To discriminate antibodies based on their ability to prevent the adhesion of HT29 cells to TGFPLAP, the following adhesion assay was performed.

[0280] Nunc MaxiSorp (Nunc) plates were coated overnight with 500_, of g/m1 TGF Betal LAP (TGFPLAP), and pre-blocked with 3% BSA/PBS for 1 hour prior to the assay. HT29 cells grown to the optimal density were then pelleted and washed twice in HBBS (with 1% BSA and without Mn2 ), after which the cells were then resuspended in HBSS at 30,000 cell per well. The coating liquid was removed from the plates, which were then blocked with 1000_, 3% BSA at room temperature for 1 hour and thereafter washed twice with PBS.

[0281] Antibody titrations were prepared in 1:3 serial dilutions in a final volume of 300_, and at two times the final concentration. Care was taken to ensure that the PBS
concentration in the control wells matched the PBS concentration in the most dilute antibody well. 300_, of cells were added to each well, and the cells were incubated in the SUBSTITUTE SHEET (RULE 26) presence of the antibodies at 4 C for 40 minutes in a V-bottom plate. The cell-antibody mixtures were transferred to the coated plate and the plate was incubated at 37 C for 40 minutes. The cells on the coated plates were then washed four times in warm HBSS, and the cells were thereafter frozen at -80 C for 15 minutes. The cells were allowed to thaw at room temperature, and then 100 1_, of CyQuant dye/lysis buffer (Molecular Probes) was added to each well according to the manufacturer's instructions. Fluorescence was read at an excitation wavelength of 485 nm and an emission wavelength of 530 nm. An estimated IC50 value for each mAb was calculated based on the maximal and minimal amount of cell adhesion possible in the assay, as determined by positive and negative control wells.
The results for twelve antibodies are summarized in Table 14.

SUBSTITUTE SHEET (RULE 26) Table 14. Adhesion Assay Results (Estimated IC50 Values) n=1 (ng/mL) n=2 (ng/mL) n=3 (ng/mL) sc 049 >5000 >5000 >5000 sc 058 4065 2028 3259 sc 097 1006 281 536 sc 133 25 16 30 sc 161 2408 137 ND
sc 188 41 26 ND
sc 254 63 37 37 sc 264 26 14 18 sc 277 1455 540 720 sc 298 29 25 33 sc 320 648 381 415 sc 374 277 300 549 Positive Control Example 20. Competition Assay

[0282] To establish that the antibodies were specifically capable of blocking aVI36 integrin binding to soluble TGFPLAP, a competition assay was run with the purified antibodies to measure their ability to bind to aVI36 and block its binding to a GST-LAP peptide.

[0283] Medium binding 96-well plates (Costar, catalog # 3368) were coated with 50 L/well of 10 g/m1GST-LAP in PBS and 0.05% sodium azide, and incubated overnight at 4 C. The plates were then washed three times using 300 L/well of assay diluent (1% milk in TBS (50mM Tris, 50mM NaC1, 1mM MgC12 and 1mM CaC12, pH
6.9), after which the plates were blocked using 300 L/well 5% milk in TBS and incubated for 30 minutes at room temperature. The mAbs (in 1:3 serial dilutions ranging from 10 g/m1 to 0.01 [tg/m1) were incubated overnight with aVI36 (250ng/m1 in assay diluent containing 0.05% sodium azide). The following day, 50 L/well of the pre-incubated primary antibody was transferred to the GST-LAP peptide-coated plate and incubated for one hour at room temperature. The wells were then washed three times using 300 L/well of assay diluent. Then, to detect the amount of aVI36 bound to the plates, mAb 2075 (Chemicon) was added at a concentration of 1iug/m1 in assay diluent (50 L/well) and incubated for one hour at room temperature. The wells were then washed three times using 300 L/well of assay diluent, and incubated with goat anti-mouse IgG

SUBSTITUTE SHEET (RULE 26) Fc-peroxidase at 400ng/m1 in assay diluent (50 L/well) for one hour at room temperature.
The wells were then washed three times using 300 L/well of assay diluent, and developed using 1-step TMB (Neogen) at a total volume of 50 L/well. After 15 minutes, the developing reaction was quenched with 50 L/well of 1N Hydrochloric acid.
The plates were read at 450nm, and the results for five of the antibodies are summarized in Figure 14, which shows that the antibodies were able to inhibit aVI36 binding to GST-LAP.
Example 21. Cross-reactivity to aVI33 or aVI35 Integrins

[0284] To establish that the antibodies were functional only against aVI36 integrin and not aVI33 or aVI35 integrins, the following assay was performed to test the ability of the antibodies to inhibit the adhesion of A375M cells to an osteopontin peptide.

[0285] Assay plates were coated with osteopontin peptide. Two fragments of osteopontin were used: OPN 17-168 and OPN 17-314. Assay plates were pre-blocked with 3% BSA/PBS for one hour prior to the assay. The A375M cells were removed from a culture flask, pelleted and washed twice with HBSS containing 1% BSA and 1mM
Ca2+
and 1mM Mg2 . The cells were then resuspended in HBSS at a concentration of 30,000 cells per well. The coating liquid containing the osteopontin fragments was removed, and the plates were blocked with 1000_, of 3% BSA for one hour at room temperature. The coated plates were washed twice with HBSS containing 1% BSA. Antibody titrations were prepared in 1:4 serial dilutions in a final volume of 30 L and at twice the final concentration. The resuspended cells were added to the wells containing the titrated antibody in a V-bottom plate, and the cells and antibodies were co-incubated at 4 C for 40 minutes. The cell-antibody mixture was then transferred to the coated plate, which was thereafter incubated at 37 C for 40 minutes. The cells on the coated plates were next washed four times in warm HBSS, and the cells in the plates were then frozen at -80 C
for 15 minutes. The cells were allowed to thaw at room temperature, and then 1000_, of CyQuant dye/lysis buffer (Molecular Probes) was added to each well according to the manufacturer's instructions. Fluorescence was read at an excitation wavelength of 485 nm and an emission wavelength of 530 nm.

[0286] The results for five of the antibodies are summarized in Table 15. A
commercially available aV integrin specific antibody was used as a positive control in this assay and exhibited about 90% inhibition of adhesion. A commercially available SUBSTITUTE SHEET (RULE 26) aV136 antibody served as a negative control in this assay for adhesion to aV133 or aV135 integrins. All antibodies were tested at a concentration of 5p.g/m1 and none of the test antibodies could block adhesion to aV133 or aV135 integrins.
Table 15. Cross-Reactivity to aVI33 or aVI35 Integrins Percent Antibody ID Inhibition sc 133 3 sc 188 -2 sc 254 -5 sc 264 3 sc 298 9 aV Control 89 aV136 Control 11 Human IgG Control 3 Mouse IgG Control 5 Example 22. Cross-reactivity to a4131 Integrin

[0287] To establish that the antibodies were functional only against the aV136 integrin and not the a4131 integrin, an assay was performed to test the ability of the antibodies to inhibit the adhesion of J6.77 cells to the CS-1 peptide of fibronectin. The assay was performed as described in Example 21 above, with the exception that J6.77 cells were used for binding and the CS-1 peptide of fibronectin was used to coat the assay plates.

[0288] The results for 11 of the antibodies are summarized in Table 16. A
commercially available 131 integrin specific antibody was used as a positive control in this assay and exhibited 97% inhibition of adhesion. A commercially available aV136 specific antibody served as a negative control in this assay for adhesion to a4131. All antibodies were used at 5p.g/m1 and none of the test antibodies could block adhesion to a4131.
Table 16. Cross-Reactivity to a4131 Integrin Percent Antibody at 5ug/m1 Inhibition sc 58 -14 sc 97 -7 sc 133 -15 sc 161 12 sc 188 -10 loo SUBSTITUTE SHEET (RULE 26) Percent Antibody at 5ug/m1 Inhibition sc 254 0 sc 264 -8 sc 277 -17 sc 298 -7 sc 320 -8 sc 374 -8 Human IgG1 -6 Human IgG2 -9 Anti-betal integrin antibody 97 Anti-aVI36 integrin antibody -15 No CS-1 or antibody on plates 12 CS-1 fragment coated plates without antibody 10 Example 23. Cross-reactivity to a5131 Integrin

[0289] To establish that the antibodies were functional only against the aVI36 integrin and not the a5131 integrin, an adhesion assay was performed to test the ability of the antibodies to inhibit the adhesion of K562 cells to fibronectin.

[0290] Assay plates were coated with the FN9-10 peptide of fibronectin at a concentration of 12.5 g/mL. Assay plates were pre-blocked with 3% BSA/PBS for one hour prior to the assay. The K562 cells were removed from a culture flask, pelleted and washed twice with HBSS containing 1% BSA and 1mM Mn2 . The cells were then resuspended in HBSS at a concentration of 30,000 cells per well. The coating liquid containing the osteopontin fragments was removed, and the plates were blocked with 1000_, of 3% BSA for one hour at room temperature. The coated plates were washed twice with HBSS containing 1% BSA. Antibody titrations were prepared in 1:4 serial dilutions in a final volume of 300_, and at twice the final concentration. The resuspended cells were added to the wells containing the titrated antibody in a V-bottom plate, and the cells and antibodies were co-incubated at 4 C for 60 minutes. The cell-antibody mixture was then transferred to the coated plate, which was thereafter incubated at 37 C for 40 minutes. The cells on the coated plates were next washed four times in warm HBSS, and the cells in the plates were then frozen at -80 C for 15 minutes. The cells were allowed to thaw at room temperature, and then 1000_, of CyQuant dye/lysis buffer (Molecular Probes) was added to each well according to the manufacturer's instructions.

SUBSTITUTE SHEET (RULE 26) Fluorescence was read at an excitation wavelength of 485 nm and an emission wavelength of 530 nm.

[0291] The results for five of the antibodies are summarized in Table 17. Test antibodies were compared to a commercially available a5I31 antibody as a positive control and an aVI36 specific antibody as a negative control. None of the test antibodies were able to block adhesion in the assay at the 5 lug/m1 concentration used in this assay.
Table 17. Cross-Reactivity to a5131 Integrin Percent Antibody ID Inhibition sc 133 -12 sc 188 5 sc 254 -9 sc 264 -4 sc 298 2 aVI36 Control 7 a5I31 Control 78 Human IgG
Control 11 Example 24. Cross-reactivity to Murine and Cynomolgus 0[136 Integrin

[0292] In order to determine whether the antibodies exhibited cross-reactivity to mouse aVI36 or Cynomolgus aVI36, the following assay was performed.

[0293] Cross-reactivity of the mAbs to macaque and mouse aVI36 was tested on the purified mAbs using FACS analysis on HEK-293 cells transiently transfected with cynomolgus or mouse aV, 136, or aVI36. Approximately 48 hours after transfection, the cells were collected and resuspended in FACS buffer to reach a final concentration of approximately 50,000 cells in 100 L.

[0294] Approximately 100,000 cells total, were used in each reaction as follows.
2000_, of 293 cells were dispensed into a V-bottom plate. The cells in the plate were pelleted at 1500 rpm for 3 minutes, and then resuspended in 100 [t.L FACS
buffer. The pelleting step was repeated, and the FACS buffer supernatant was removed. The purified mAbs, or control primary antibodies were added in a volume of 50 [t.L and the cells were resuspended. Primary antibody controls were murine aVI36 (Cat#MAB2077z, Chemicon) and anti-aV and anti-I36 recombinants. The plate was incubated on ice for 45 minutes, after which 100 [t.L FACS buffer was added to dilute the primary antibody. The cells SUBSTITUTE SHEET (RULE 26) were then pelleted by centrifuging at 1500 rpm for 3 minutes, and the pellet was resuspended in 100 [iL FACS buffer. The pelleting step was repeated, and the FACS
buffer supernatant was removed. Cells were then resuspended in the appropriate secondary antibody (5 'Lig/nal) with 7AAD dye (10 [ig/m1), and stained on ice for 7 minutes. Then 150 [iL of FACS buffer was added and the cells were pelleted at 1500 rpm for 3 minutes, after which the cells were washed in 100 [iL FACS buffer, pelleted, and then resuspended in 250 [iL buffer and added to FACS tubes. Samples were analyzed on a high throughput FACS machine and analyzed using Cell Quest Pro software.

[0295] The results are summarized in Table 18, and demonstrate that mAb sc 133 and mAb sc 188 were clearly cross-reactive with mouse and Cynomolgus aV136 and P6. mAb sc 254 appeared to cross-react with 136, aV, and aV136. mAbs sc 264 and 298 had high levels of binding to parental cells making species cross-reactivity difficult to discern.
Table 18. Cross-Reactivity with Mouse and Cynomolgus aVI36 Mous Cynomolg Mous Mouse . Parent e Cynomolg Cynomolg us Antibodies e alphaVbet al alpha beta6 a6 us alphaV us beta6 alphaVbet V a6 Cells alone Gt anti Mouse anti alphaVbet 0 1 11 45 0 5 20 a6 anti alphaV
anti beta6 0 0 0 0 0 0 0 Gt anti Human Human IgG1 0 0 0 sc.133 2 4 19 49 5 10 28 sc.188 1 3 29 51 2 17 27 sc.254 8 13 21 50 16 19 26 sc.264 74 71 68 63 70 75 54 sc.298 49 45 52 53 48 52 38 Data represent percent of cells shifted SUBSTITUTE SHEET (RULE 26) Example 25. Internalization Assay

[0296] The internalization of the antibodies was tested using a K562 cell line that stably expressed human aVI36. Internalization of the purified antibodies was compared to a commercially available aVI36 antibody that was not internalized in this assay.

[0297] The results are summarized in Table 19.
Table 19. Summary of the Internalization Assay Concentration Percent Antibody (ug/mL) Internalization sc 133 10 28%
sc 133 1 30%
sc 188 10 38%
sc 188 1 34%
sc 254 10 49%
sc 254 1 39%
sc 264 10 76%
sc 264 1 77%
sc 298 10 28%
sc 298 1 26%
Example 26. High Resolution Biacore Analysis

[0298] High resolution Biacore analysis using a soluble aVI36 protein to bind antibodies immobilized on CM5 chips was performed for 5 of the aVI36 antibodies to estimate their affinity for soluble antigen.

[0299] The Biacore analysis was performed as follows. A high-density goat a human IgG antibody surface over two CM5 Biacore chips was prepared using routine amine coupling. Each mAb was diluted in degassed HBS-P running buffer containing 100 [tg/m1 BSA, 1mM MgC12, and 1mM CaC12 to a concentration of approximately 1 [tg/mL.
More precisely, mAb sc 133 was diluted to 0.98 [tg/mL, mAb sc 188 was diluted to 0.96 [tg/mL, mAb sc 264 was diluted to 0.94 [tg/mL, mAb sc 254.2 was diluted to 0.87 [tg/mL, and mAb sc 298 was diluted to 1.6 [tg/mL. Then, a capture level protocol was developed for each mAb by capturing each mAb over a separate flow cell at a 10 IAL/min flow rate at the concentrations listed above. mAbs sc 133, sc 298, and sc 254.2 were captured for 30 seconds while mAbs sc 188 and sc 264 were captured for 1 minute. A 4-minute wash step at 50 IAL/min followed to stabilize the mAb baseline.

SUBSTITUTE SHEET (RULE 26)

[0300] Soluble aVI36 was injected for 4 minutes at a concentration range of ¨ 3.6 nM for mAbs sc 133, sc 188, sc 264, and sc 298, and 233 ¨ 3.6 nM for mAb sc 254.2, with a 2x serial dilution for each concentration range. A 10-minute dissociation followed each antigen injection. The antigen samples were prepared in the HBS-P
running described above. All samples were randomly injected in triplicate with several mAb capture/buffer inject cycles interspersed for double referencing. The high-density goat a mouse antibody surfaces were regenerated with one 18-second pulse of 146 mM
phosphoric acid (pH 1.5) after each cycle at a flow rate of 100 IAL/min. A
flow rate of 50 pL/min was used for all antigen injection cycles.

[0301] The data were then fit to a 1:1 interaction model with the inclusion of a term for mass transport using CLAMP. The resulting binding constants are listed in Table 20. The mAbs are listed from highest to lowest affinity.
Table 20. Affinity Determination Results for Cloned and Purified mAbs Derived from High Resolution BiacoreTm.
Antibody Rmax ka (M-1-s-1-) ka (s-1) KD (nM) sc 264 96 5.85X 104 3.63 X 10-4 6.2 sc 298 77 5.65X 104 1.18 X 10-3 21.0 sc 188 76 4.52X 104 9.56X 10-4 21.2 sc 133 96 5.73 X 104 1.89 X 10-3 33.0 sc 254.2 53, 45 5.73 X 104 5.64 X 10-4 34.9 Example 27. Binding Affinity Analysis Using FACS

[0302] As an alternative to Biacore, FACS analysis was also used to estimate the binding affinity of one of the antibodies to K562 cells that stably express the human aVI36 antigen. The amount of antigen was titrated to generate a binding curve and estimate the binding affinity to the antigen.

[0303] K562 cells expressing aVI36 were resuspended in filtered HBS buffer containing 1 mM of MgC12 and 1 mM of CaC12 at a concentration of approximately million cells/mL. The cells were kept on ice. Purified mAb sc 188 was serially diluted by a factor of 1:2 in HBS across 11 wells in a 96-well plate. The 12th well in each row contained buffer only. Titrations were done in triplicate. Additional HBS and cells were added to each well so that the final volume was 3001AL/well and each well contained approximately 120,000 cells. The final molecular concentration range for mAb sc 188 SUBSTITUTE SHEET (RULE 26) was 4.9 ¨ 0.019 nM. The plates were placed into a plate shaker for 5 hours at 4 C, after which the plates were spun and washed three times with HBS, following which, of 131 nM Cy5 goat a-human polyclonal antibody (Jackson Laboratories, #109-175-008) were added to each well. The plates were then shaken for 40 minutes at 4 C, and thereafter were spun and washed once again three times with HBS. The Geometric Mean Fluorescence (GMF) of 20,000 "events" for each mAb concentration was recorded using a FACSCalibur instrument, and the corresponding triplicate titration points were averaged to give one GMF point for each mAb concentration. A plot of the averaged GMF
as a function of molecular mAb concentration with Scientist software was fit nonlinearly using the equation:
õ.\ 2 , (KD LT + n=M) ¨.1(KD + LT + n=ivi) ¨ -A En=ivi=L,T
F = P' _______________________________________________________ + B

[0304] In the above equation, F = geometric mean fluorescence, LT = total molecular mAb concentration, P' = proportionality constant that relates arbitrary fluorescence units to bound mAb, M = cellular concentration in molarity, n =
number of receptors per cell, B = background signal, and KD = equilibrium dissociation constant. For mAb sc 188 an estimate for KD is obtained as P', n, B, and KD are allowed to float freely in the nonlinear analysis.

[0305] The resulting plot with its nonlinear fits (red line) is shown in Figure 15.
Table 21 lists the resulting KD for mAb sc 188 along with the 95% confidence interval of the fit. These results for mAb sc 188 indicate binding to one type of receptor.

[0306] Binding affinity for sc 188 as determined by FACS was significantly tighter than as determined by Biacore (Example 26). There are at least 2 possible explanations for the difference in KD values for sc 188. The first reason is that the two assays used different forms of the antigen for the measurement ¨ Biacore used soluble antigen and the FACs analysis used a cell-bound form of the antigen. The second reason is that the antibodies that were tested were raised against the cell-bound form of the antigen and may not bind with as high an affinity to the soluble antigen as they do to the cell-bound antigen.
Table 21. Binding Affinity Analysis Using FACS
Antibody KD (PM) 95% CI (pM) SUBSTITUTE SHEET (RULE 26) sc 188 51.9 +22.7 Example 28. CDC Assay

[0307] The purified antibodies described in the examples above are of the IgG1 isotype and can have effector function. In order to determine the ability of these antibodies to mediate complement-dependent cytotoxicity (CDC), the following assay was performed using 293 cells stably expressing aVI36 (293-10A11) and parental cells (293F).

[0308] For calcein staining of cells, aliquots of approximately 25 X 10e6 each of HT29, 293-10A11, and 293F cells were individually resuspended in 3m1 serum-free RPMI media. 450_, of 1mM calcein was then added to each 3m1 sample of cells, and the samples were incubated at 37 C for 45 minutes. The cells were centrifuged at 1200xRPM
for 3 minutes, the supernatant was discarded and the cells were resuspended in each respective cell line's culture media. The centrifugation step was repeated and the cells were resuspended to give a final concentration of about 100,000 cells in 500_, media.

[0309] Serial 1:2 dilutions of each antibody were prepared in a v-bottom 96-well plate, with concentrations ranging from 20 g/m1 to 0.625 g/m1 in a volume of 50 [IL.
Then, 100,000 of the cells prepared as described above were added in a volume of 50 [t.L
to the antibody-containing plates, and the resulting mixture was incubated on ice for two hours. Following the incubation, the cells were pelleted, and the supernatant was discarded. The cells were resuspended in 1000_, of their respective media containing 10%
human sera (ABI donor #27), and incubated at 37 C for 30 minutes. The cells were then centrifuged, and 800_, of the supernatant was transferred to a FMAT plate. The plate was read on a Tecan reader using an excitation wavelength of 485nm and an emission wavelength of 530nm.

[0310] The results are summarized in Figures 16A-3E, and demonstrate that each purified antibody tested is capable of mediating CDC in 293 cells stably expressing 07136 integrin.
Example 29. Site-directed Mutagenesis

[0311] One of the antibodies (sc 264) prepared from the immunizations (Example 1) showed strong functional blocking activity in vitro in the TGFOLAP
binding inhibition assay (see Example 4), but exhibited cross-reactive binding to non-aVI36 SUBSTITUTE SHEET (RULE 26) expressing cell lines (see Example 24). This antibody, sc 264, has an RGD
sequence in the CDR3 region, which is presumed to be responsible for the cross-reactive binding.
Therefore, site-directed mutagenesis was used to replace the glycine residue in the RGD
with an alanine (sc 264 RAD).

[0312] A second antibody (sc 188) has a glycosylation site within the FR3 region. This site was eliminated through site-directed mutagenesis with a substitution from NLT to KLT (sc 188 SDM). The mutated versions of these two antibodies were then expressed and purified as described in Examples 7 and 8, and the purified antibodies were analyzed as described in the following examples.
Example 30. Binding Assay to Test Cross-Reactive Binding of Mutant Antibodies

[0313] A binding assay was performed to test whether the cross-reactive binding observed in Example 24 was reduced because of site-directed mutagenesis of sc 264.
Binding of the antibodies was analyzed on 293T and 293F cell lines to test whether removing the RGD site from sc 264 would result in decreased binding compared with the original antibody.

[0314] 293T and 293F cells were spun down after collection and resuspended in HBSS with 1% BSA and 1mM CaC12 and 1mM MgC12 (wash buffer), so that at least 150,000 cells were used in each reaction. Cells were divided between reactions in a V-bottom 96-well plate (Sarstedt), and the cells in the plate were pelleted at 1500 rpm for 3 minutes, after which the HBSS supernatant was removed. The primary antibody was added at the concentration indicated in Table 19 in a volume of 50 L, and the cells were resuspended and thereafter incubated on ice for 60 minutes. After incubation, the cells were pelleted by centrifugation at 1500 rpm for 3 minutes, resuspended in 100 L wash buffer, and then pelleted again. Cells were then resuspended in the appropriate secondary antibody at 2p.g/m1 with 10 g/m17AAD, and stained on ice for 7 minutes, after which 150 [t.L of wash buffer was added, and cells were pelleted at 1500 rpm for 3 minutes and then resuspended in 100 L of HBSS with 1% BSA. Samples were read on a FACS
machine with a HTS attachment and the data was analyzed using Cell Quest Pro software.
The results are summarized in Table 22, and data appears as Geometric Mean Shift values in arbitrary units. These data demonstrate that at all concentrations tested, sc 264 RAD
had significantly less binding to parental 293T cells compared to the original mAb sc 264.

SUBSTITUTE SHEET (RULE 26) Table 22. Cross-reactivity of mutated antibodies to parental cells.
Antibody Concentration (ug/ml) 293T Cells 293T-aVI36 Cells None n/a 3 2 Mouse IgG2a 20 27 8 Human IgG1 20 4 4 Anti-aVb6 20 4 5 sc 264 20 433 6673 sc 264 RAD 20 44 7241 sc 188 20 27 6167 sc 188 SDM 20 25 6758 sc 264 5 88 6418 sc 264 RAD 5 13 6840 sc 188 5 9 5822 sc 188 SDM 5 9 6822 sc 264 1.25 24 6230 sc 264 RAD 1.25 7 4890 sc 188 1.25 6 6395 sc 188 SDM 1.25 5 4532 Example 31. Potency Analysis of Mutant Antibodies

[0315] In order to determine the concentration (IC50) of mutant aVI36 antibodies required to inhibit TGFPLAP-mediated adhesion of HT-29 cells, the following assay was performed.

[0316] Nunc MaxiSorp (Nunc) plates were coated overnight with 500_, of g/m1 TGF Betal LAP (TGFPLAP), and pre-blocked with 3% BSA/PBS for 1 hour prior to the assay. HT29 cells grown to the optimal density were then pelleted and washed twice in HBBS (with 1% BSA and with 1mM Ca2+ and 1mM Mg2 ), after which the cells were then resuspended in HBSS at 30,000 cell per well. The coating liquid was removed from the plates, which were then blocked with 1000_, 3% BSA at room temperature for 1 hour and thereafter washed twice with PBS.

[0317] Antibody titrations were prepared in 1:4 serial dilutions in a final volume of 300_, and at two times the final concentration. Care was taken to ensure that the PBS
concentration in the control wells matched the PBS concentration in the most dilute antibody well. 300_, of cells were added to each well, and the cells were incubated in the presence of the antibodies at 4 C for 40 minutes in a V-bottom plate. The cell-antibody mixtures were transferred to the coated plate and the plate was incubated at 37 C for 40 minutes. The cells on the coated plates were then washed four times in warm HBSS, and SUBSTITUTE SHEET (RULE 26) the cells were thereafter frozen at -80 C for 15 minutes. The cells were allowed to thaw at room temperature, and then 1000_, of CyQuant dye/lysis buffer (Molecular Probes) was added to each well according to the manufacturer's instructions. Fluorescence was read at an excitation wavelength of 485 nm and an emission wavelength of 530 nm. The results for twelve antibodies are summarized in Table 23, and demonstrate that the IC50 of the mutant antibodies is consistently less than that of each original antibody.
Table 23. Concentration (IC50) of mutant antibodies required to inhibit TGFPLAP-mediated adhesion of HT29 cells.
n=1 (ng/ml) n=2 (ng/ml) n=3 (ng/ml) sc.264 113 96 55 sc.264 sc.264 57 89 46 sc.188 125 157 64 sc.188 Example 32. Cross-Reactivity of Mutant Antibodies to a4131 Integrin

[0318] To establish that the mutant antibodies were functional only against the aVI36 integrin and not the a4131 integrin, an assay was performed to test the ability of the antibodies to inhibit the adhesion of J6.77 cells to the CS-1 peptide of fibronectin. The assay was performed as described as described below.

[0319] Assay plates were coated with the CS-1 peptide of fibronectin. Assay plates were pre-blocked with 3% BSA/PBS for one hour prior to the assay. The J6.77 cells were grown to confluency, then removed from a culture flask, pelleted and washed three times with HBSS. The cells were then resuspended in HBSS at a concentration of 30,000 cells per well. The coating liquid containing the fibronectin fragments was removed, and the plates were blocked with 1000_, of 3% BSA for one hour at room temperature. The coated plates were washed three times with HBSS. Antibody titrations were prepared in 1:4 serial dilutions in a final volume of 300_, and at twice the final concentration. The resuspended cells were added to the wells containing the titrated antibody in a V-bottom plate, and the cells and antibodies were co-incubated at 4 C for 40 minutes. The cell-antibody mixture was then transferred to the coated plate, which was thereafter incubated at 37 C for 40 minutes. The cells on the coated plates were next washed four times in warm HBSS, and the cells in the plates were then frozen at -80 C

SUBSTITUTE SHEET (RULE 26) for 15 minutes. The cells were allowed to thaw at room temperature, and then 1000_, of CyQuant dye/lysis buffer (Molecular Probes) was added to each well according to the manufacturer's instructions. Fluorescence was read at an excitation wavelength of 485 nm and an emission wavelength of 530 nm.

[0320] The results for the two mutant antibodies and their non-mutated counterparts are summarized in Table 24. A commercially available 131 integrin specific antibody was used as a positive control in this assay and exhibited 95%
inhibition of adhesion. A commercially available aV136 specific antibody served as a negative control in this assay for adhesion to a4131. All antibodies were used at 5p.g/m1 and none of the test antibodies could block adhesion to a4131.
Table 24. Cross-Reactivity to a4131 Integrin Antibody at Percent 5ug/m1 Inhibition sc.188 2 sc.188 SDM -6 sc.264 -30 sc.264 RAD -2 Human IgG1 26 Human IgG2 13 Human IgG4 15 Anti-beta 1 Integrin 95 Example 33. Cross-Reactivity of Mutant Antibodies to a5131 Integrin

[0321] To establish that the mutant antibodies were functional only against the aV136 integrin and not the a5131 integrin, an assay was performed to test the ability of the antibodies to inhibit the adhesion of K562 cells to fibronectin. The assay was performed as described as described in Example 14. The results are summarized in Table 25, and demonstrate that none of the tested antibodies could block adhesion to a5131.
Table 25. Cross-Reactivity to a5131 Integrin.
Antibody ID % Inhibition sc 188 -5 sc 188 SDM -8 sc 264 3 sc 264 RAD 6 aV136 Control -16 SUBSTITUTE SHEET (RULE 26) a5131 Control 78 Human IgG
Control -12 Example 34. Cross-Reactivity Of Mutant Antibodies To Mouse And Cynomolgus av136 Integrin

[0322] In order to determine if the mutant aVI36-specific antibodies exhibit cross-reactivity to mouse aVI36 or Cynomolgus aVI36, the following assay was performed.

[0323] K562 parental cells, or K562 cells expressing Cynomolgus or mouse aVI36 were spun down after collection and resuspended in HBSS with 1% BSA and 1mM
CaC12 and 1mM MgC12 (wash buffer), so that at least 150,000 cells were used in each reaction. Cells were divided between reactions in a V-bottom 96-well plate (Sarstedt), and the cells in the plate were pelleted at 1500 rpm for 3 minutes, after which the HBSS
supernatant was removed. The primary antibody was added in a volume of 50 L, and the cells were resuspended and thereafter incubated on ice for 60 minutes. After incubation, the cells were pelleted by centrifugation at 1500 rpm for 3 minutes, resuspended in 1000_, wash buffer, and then pelleted again. Cells were then resuspended in the appropriate secondary antibody at 2p.g/m1 with 10 g/m17AAD, and stained on ice for 7 minutes, after which 150 [t.L of wash buffer was added, and cells were pelleted at 1500 rpm for 3 minutes and then resuspended in 1000_, of HBSS with 1% BSA. Samples were read on a FACS machine with a HTS attachment and the data was analyzed using Cell Quest Pro software. The results are summarized in Table 26, and data appears as Geometric Mean Shift values in arbitrary units. These data demonstrate that at the concentrations tested, sc 264 RAD and sc 188 SDM exhibit cross-reactivity to mouse and cynomolgus aVI36.
Table 26. Cross-Reactivity with Mouse and Cynomolgus aVI36 Mouse Cynomolgus Antibodies Parental alphaVbeta6 alphaVbeta6 Cells Alone 3 3 3 Gt anti Mouse anti alphaVbeta6 anti alphaV 109 144 163 anti beta6 26 43 37 Mouse IgG2a 23 36 25 SUBSTITUTE SHEET (RULE 26) Mouse IgG1 12 20 13 Gt anti Human Human IgG1 46 108 54 sc 133 57 246 154 sc 188 55 227 139 sc 188 SDM 47 219 142 sc 254 98 260 190 sc 264 33 160 121 sc 264 RAD 48 196 139 sc 298 33 150 97 Example 35. Internalization Assay

[0324] The internalization of the mutant antibodies was tested using a K562 cell line that stably expressed human aVI36. The assay was performed as described in Example 24. Internalization of the purified antibodies was compared to a commercially available aVI36 antibody that was not internalized in this assay.

[0325] The results are summarized in Table 27, and demonstrate that the sc 264 RAD mutant antibody is internalized significantly less than the non-mutated sc 264.
Table 27. Summary of the Internalization Assay Antibody Concentration (ug/ml) Percent Internalization sc 264 10 75%
sc 264 1 47%
sc 264 RAD 10 42%
sc 264 RAD 1 31%
sc 188 10 18%
sc 188 1 27%
sc 188 SDM 10 22%
sc 188 SDM 1 17%
Example 36. Binding Affinity Analysis of sc 264 RAD Using FACS

[0326] The binding affinity to aVI36 of the sc 264 RAD antibody was measured as described in Example 18. The results of this assay are summarized in Table 28, and demonstrate that the sc 264 RAD antibody has an affinity <50pM.
Table 28. Binding Affinity Analysis Using FACS
mAb Sample KD (PM) 95% CI (pM) SUBSTITUTE SHEET (RULE 26) sc 264 RAD 46.3 + 15.9 Example 37. Comparison of the Activity of sc 264 RAD with sc 264 RAD/ADY

[0327] The activity of sc 264 RAD antibody and the germlined (GL) version of 264RAD (containing the mutation A84D in the light chain), 264 RAD/ADY were compared in a Detroit-562 adhesion assay.

[0328] Plates were coated with 0.51Ag/m1GST-TGF-b LAP fusion protein at 4 C
overnight and the following morning, washed, and then blocked with 3% BSA/PBS
for 1 hour. Detroit-562 cells (25000 cells per well) were then allowed to adhere to the plates for 45 minutes at 37 C in HBSS containing 2mM MgC12. After 45 minutes the plates were washed three times in PBS and then fixed in ethanol. Cells were visualized by staining with Hoescht and quantitated by counting the number of cells bound per well on a Cellomics Arrayscan II.

[0329] The data shown in Figure 18 indicates that both sc 264 RAD and sc 264 RAD/ADY have similar activity and that the ability to block aVI36 function is maintained in the modified antibody.
Example 38. Growth Study

[0330] To establish that the antibodies 264RAD, 133 and 188 SDM block avb6 function in vivo each were tested for the ability to inhibit growth of aVI36 positive tumour xenograft. One such model is the Detroit-562 nasophayngeal cell line, which expresses aVI36 and also grows as a sub-cutaeneous tumour xenograft.

[0331] Detroit 562 cells were cultured in EMEM with Earle's BSS and 2mM L-Glu + 1.0 mM sodium pyruvate, 0.1mM NEAA + 1.5g/L sodium bicarbonate + 10%
FBS.
Cells were harvested and resuspended in 50% PBS + 50% matrigel. The suspension was then implanted at 5x10-6 per mouse in a volume of 0.1 ml within the right flank. Animals were 6-8 week old NCR female nude mice. Dosing was initiated when tumours reached 0.1 cm3 and dosed at 20mg/kg once weekly for the duration of the study.

[0332] All three antibodies inhibited tumour growth (see figure 17). 264RAD
was the most effective, followed by 133, and 188. This data clearly shows that the antibodies 264RAD, 133 and 188 are active in vivo and are able reduce the growth of a tumour dependent on aVI36 signaling for growth.

SUBSTITUTE SHEET (RULE 26) Table 29 Exemplary Antibody Heavy Chain Amino Acid Sequences t..) Chain SEQ
=

u, Name O-NO:
.6.
o QVQLQESGP GGSIS
RVTISVDTSKNQFS VATGRA t..) sc 264 c4 o RAD WIG NNPSLKS
TVTVSS
SLTCTVS WS
YYCAR MDV
Sc 264 QVQLQESGP GGSISS
RVTISVDTSKNQFS VATGRA
WIRQHPGKGLE YIYYSGRTY
WGQGT

cf) WIG NNPSLKS
TVTVSS
c DY LTCTVS WS
YYCAR MDV
co QVQLQESGP GGSISS
RVTISVDTSKKQFS EGPLRGD
(A sc 188 GLVKPSQTLS GVYY LKLTSVTAADTAV YYYGLD WGQGT
SDM WIG NPSLKS
TVTVSS
c LTCTVS WT
YYCAR V P
H QVQLVQSGA GYTFT

m 5c133 WVRQAPGQGL WINPKSGDT

cf) 79 EVKKPGAS V GYYM
MELSRLRSDDTAV RLDV u, = TMT EWMG NYAQKFQG
TVTVSS ,2 m '''' KVSCKAS H
YYCAR , m QVQLVQSGA GYTFT
RVTLTRDTSTSTAY .
H Sc 133 WVRQAPGQGL WINPKSGDT
WGQGT
, --..) EWMG NYAQKFQG
MELSRLRSDDTAV RLDV
TVTVSS

c KVSCKAS H
YYCAR
r m Sc 133 QVQLVQSGA GYTFT
RVTMTRDTS TS TAY

WVRQAPGQGL WINPKSGDT
WGQGT
N.) MELSRLRSDDTAV RLDV
cn EWMG NYAQKFQG
TVTVSS
DS KVSCKAS H
YYCAR
Table 30 Exemplary Antibody Light Chain Amino Acid Sequences od n Chain SEQ

FR3 CDR3 FR4 m Name od NO:
t..) o SYELTQPSSV SGDVL
GIPERFSGSSSGTTV
Sc 264 WFHQKPGQAP
YSAADN FGGGTK O' RAD VLVIY
NLV LTVL
o TC R
YYC t..) oe sc 264 SYELTQPSSV SGDVL
GIPERFSGSSSGTTV
WFHQKPGQAP

TLTISGAQVEDEAD t..) VLVIY
NLV LTVL =
DY TC R
YYC
u, EIVLTQSPGT RAGQT
GIPDRFSGSGSGTDF O-4,.
Sc 188 WYQQKPGQAP
QQYGSSP FGQGTK ,o TLTISRLEPEDFAVY t..) SDM RPLIY
RT VEIK c4 o LSC A
YC
QSVLTQPPSV SGSSS
GIPDRFSGSKSGTSA
Sc 133 WYQQLPGTAP
GTWNSSL FGTGTK

TLGITGLQTGDEAD
TMT KLLIY
SAGYV VTVL
SC YVS
YYC
cf) QSVLTQPPSV SGSSS
GIPDRFSGSKSGTSA
c Sc133 WYQQLPGTAP
GTWDSSL FGTGTK
co DNNKRPS TLGITGLQTGDEAD

cf) WDS KLLIY
SAGYV VTVL
H SC YVS
YYC
c Sc 133 QSVLTQPPSV SGSSS
GIPDRFSGSKSGTSA P
¨I TMT/VV 89 SAAPGQKVTI NIGNN WYQQLPGTAP
DNNKRPS
TLGITGLQTGDEAD GTWDSSL FGTGTK

m KLLIY

cf) DS SC YVS
YYC
=
5?, _., m m , H
.
, ,:, c ,, r rrl NJ
cn od n 1-i m od t..) o 4,.
O-o t..) oo REFERENCES

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INCORPORATION BY REFERENCE

[0375] All references cited herein, including patents, patent applications, papers, text books, and the like, and the references cited therein, to the extent that they are not already, are hereby incorporated herein by reference in their entirety for all purposes.
EQUIVALENTS

[0376] The foregoing written specification is considered to be sufficient to enable one skilled in the art to practice the embodiments. The foregoing description and Examples detail certain embodiments and describes the best mode contemplated by the inventors.
It will be SUBSTITUTE SHEET (RULE 26) appreciated, however, that no matter how detailed the foregoing may appear in text, the embodiment may be practiced in many ways and should be construed in accordance with the appended claims and any equivalents thereof.

SUBSTITUTE SHEET (RULE 26)

Claims (93)

WHAT IS CLAIMED IS:

1. A method of treating a malignant tumor in an animal comprising administering to said animal in need thereof a therapeutically effective dose of:
a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6; and b. optionally a combination therapy agent.

2. A method of inhibiting growth of tumor cells comprising administering to the tumor cells a therapeutically effective dose of:
a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6; and b. optionally a combination therapy agent.

3. The method of any one of claims 1-2, wherein .alpha.V.beta.6 is overexpressed.

4. The method of any one of claims 1-3, wherein a combination therapy agent is administered.

5. The method of any one of claims 1-4, wherein the .alpha.V.beta.6 targeted binding agent and the combination therapy agent are administered simultaneously.

6. The method of any one of claims 1-4, wherein the .alpha.V.beta.6 targeted binding agent and the combination therapy agent are administered sequentially.

7. The method of any one of claim 1-6, wherein the malignant tumor comprises tumor cells chosen from breast cancer cells, ovarian cancer cells, pancreatic cancer cells, lung cancer cells, colorectal cancer cells, head and neck cancer cells, oesophageal cancer cells, gastric cancer cells, and hepatocellular cancer cells.

8. The method of any one of claims 1-7, wherein said animal is human.

9. The method of any one of claims 1-8, wherein the combination therapy agent is a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

10. The method of any one of claims 1-9, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TNF.alpha.
convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K
inhibitor, ATK inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha. inhibitor, PI3K.beta. inhibitor, AZD8186, GSK2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF

inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

11. The method of any one of claims 1-10, wherein the tumor cells are breast cancer cells.

12. The method of any one of claims 1-11, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TNF.alpha.
convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K
inhibitor, ATK inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha. inhibitor, P13K.beta. inhibitor, AZD8186, GSK2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF

inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

13. The method of any one of claims 1-10, wherein the tumor cells are ovarian cancer cells.

14. The method of any one of claims 1-13, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TNF.alpha.
convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K
inhibitor, ATK inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha. inhibitor, PI3K.beta. inhibitor, AZD8186, G5K2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF

inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

15. The method of any one of claims 1-12, wherein the breast cancer cells are resistant to trastuzumab treatment.

16. The method of any one of claims 1-10, 13 or 14, wherein the ovarian cancer cells are resistant to trastuzumab treatment.

17. The method of any one of claims 1-16, wherein the HER2 targeted binding agent is trastuzumab.

18. The method of any one of claim 1-17, wherein the .alpha.V.beta.6 targeted binding agent is sc 264RAD.

19. The method of any one of claims 1-18, wherein the method inhibits .alpha.V.beta.6 and HER2.

20. The method of any one of claims 1-19, wherein the level of at least one of .alpha.V.beta.6, HER2, HER3, and B6 is downregulated.

21. The method of any one of claims 1-20, wherein the level of at least one downstream target of .alpha.V.beta.6 and/or HER2 is downregulated.

22. The method of any one of claims 1-21, wherein the level of at least one of Akt2 and Smad2 is downregulated.

23. The method of any one of claims 1-22, wherein the total level of the target is downregulated.

24. The method of any one of claims 1-23, wherein the phospho level of the target is downregulated.

25. The method of any one of claims 1-24, wherein more than one .alpha.V.beta.6 targeted binding agents are used.

26. The method of any one of claims 1-25, wherein more than one combination therapy agents are used.

27. The method of any one of claims 1-26, wherein the tumor cells are pancreatic cancer cells.

28. The method of any one of claims 1-27, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TNF.alpha.
convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K
inhibitor, ATK inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha. inhibitor, PI3K.beta. inhibitor, AZD8186, GSK2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF

inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

29. The method of any one of claims 1-26, wherein the tumor cells are lung cancer cells.

30. The method of any one of claims 1-26 and 29, wherein the lung cancer cells are adenocarcinoma cells, squamous cell carcinoma cells, or small cell lung cancer cells.

31. The method of any one of claims 1-26, 29, and 30, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR
inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TINF.alpha. convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K
inhibitor, ATK inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha. inhibitor, PI3K.beta. inhibitor, AZD8186, G5K2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK
inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

32. The method of any one of claims 1-26, wherein the tumor cells are colorectal cancer cells.

33. The method of any one of claims 1-26 and 32, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TNF.alpha. convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K inhibitor, ATK
inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha.
inhibitor, PI3K.beta.
inhibitor, AZD8186, GSK2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

34. The method of any one of claims 1-26, wherein the tumor cells are head and neck cancer cells.

35. The method of any one of claims 1-26 and 34, wherein the combination therapy agent is chosen from trastuzumab, HER-2 inhibitor, trastuzumab, Herceptin®, gemcitabine, abraxane, folfirinox , docetaxel, EGFR inhibitor, VEGFR inhibitor, gefitinib, AZD9291, erlotinib, platinum-based cytotoxics, platinum-based triplets, triplet chemotherapy, sorafanib, TNF.alpha. convertase enzyme inhibitor, radiation, 5-fluorouracil, cetuximab, PI3K inhibitor, ATK
inhibitor, AZD5363, MK2206, rapalogue, everolimusAZD2014, PI3K.alpha.
inhibitor, PI3K.beta.
inhibitor, AZD8186, GSK2636771, SAR 260301, Pan PI3K inhibitor, GDC0941, GDC0942, MEK/RAF inhibitor, vemurafanib, RAF inhibitor, seluemetinib, MEK inhibitor, trametinib, MEK inhibitor, PD-1 inhibitor, PDL1 inhibitor, or CTLA4 inhibitor.

36. The method of any one of claims 1-26, wherein tumor cells are oesophageal cancer cells.

37. The method of any one of claims 1-26 and 36, wherein the combination therapy agent is chosen from radiation or a chemotherapeutic agent.

38. The method of any one of claims 1-26, wherein the tumor cells are gastric cancer cells.

39. The method of any one of claims 1-26 and 38, wherein the combination therapy agent is triplet chemotherapy.

40. The method of any one of claims 1-26, wherein the tumor cells are hepatocellular cancer cells.

41. The method of any one of claims 1-26 and 40, wherein the combination therapy agent is chosen from be sorafanib and TACE (TNE.alpha. convertase enzyme) inhibitor.

42. A method of suppressing growth of trastuzumab-resistant tumor cells comprising administering to said cells a therapeutically effective dose of:

a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

43. The method of claim 42, wherein the HER2 targeted binding agent is trastuzumab.

44. The method of any one of claims 1-43, wherein the .alpha.V.beta.6 targeted binding agent is sc 264RAD.

45. The method of any one of claims 1-44, wherein the .alpha.V.beta.6 targeted binding agent is a monoclonal antibody.

46. The method of any one of claims 1-45, wherein the .alpha.V.beta.6 targeted binding agent is a fully human monoclonal antibody.

47. The method of any one of claims 1-46, wherein the .alpha.V.beta.6 targeted binding agent inhibits greater than 99% of TGF.beta.-LAP mediated adhesion of HT29 cells.

48. The method of any one of claims 1-47, wherein the .alpha.V.beta.6 targeted binding agent inhibits TGF.beta.-LAP mediated adhesion of HT29 cells with an IC50 of less than 0.070 µg/ml.

49. The method of any one of claims 1-48, wherein the .alpha.V.beta.6 targeted binding agent binds .alpha.V.beta.6 with a Kd of less than 35 nanomolar (nM).

50. The method of any one of claims 1-49, wherein the .alpha.V.beta.6 targeted binding agent binds .alpha.V.beta.6 with a Kd of less than 25 nanomolar (nM).

51. The method of any one of claims 1-50, wherein the .alpha.V.beta.6 targeted binding agent binds .alpha.V.beta.6 with a Kd of less than 10 nanomolar (nM).

52. The method of any one of claims 1-51, wherein the .alpha.V.beta.6 targeted binding agent binds .alpha.V.beta.6 with a Kd of less than 60 picomolar (pM).

53. The method of any one of claims 1-52, wherein the .alpha.V.beta.6 targeted binding agent is the monoclonal antibody sc 264RAD, sc 264 RAD/ADY, sc 188 SDM, sc 133, sc 133 TMT, sc 133 WDS, sc 133 TMT/WDS, sc 188, sc 254, sc 264, or sc 298.

54. The method of any one of claims 1-53, wherein the istV136 targeted binding agent comprises at least the VH CDR3 having amino acids 98-102 of SEQ ID NO.: 14.

55. The method of any one of claims 1-54, wherein the .alpha.V.beta.6 targeted binding agent comprises at least the VH CDR3 having amino acids 99-113 of SEQ ID NO.: 22.

56. The method of any one of claims 1-55, wherein the .alpha.V.beta.6 targeted binding agent comprises at least the VH CDR3 having amino acids 99-117 of SEQ ID NO.: 26.

57. The method of any one of claims 1-56, wherein the .alpha.V.beta.6 targeted binding comprises at least the VH CDR3 having amino acids 99-114 of SEQ ID NO.: 30.

58. The method of any one of claims 1-57, wherein the .alpha.V.beta.6 targeted binding agent comprises at least the VH CDR3 having amino acids 97-113 of SEQ ID NO.: 38.

59. The method of any one of claims 1-58, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 14.

60. The method of any one of claims 1-59, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 22.

61. The method of any one of claims 1-60, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 26.

62. The method of any one of claims 1-61, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 30.

63. The method of any one of claims 1-62, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 38.

64. The method of any one of claims 1-63, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 71.

65. The method of any one of claims 1-64, wherein the .alpha.V.beta.6 targeted binding agent comprises a heavy chain polypeptide having the sequence of SEQ ID NO.: 75.

66. The method of any one of claims 1-65, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated human monoclonal antibody comprising a. a heavy chain variable region comprising CDR1, CDR2, and CDR3 sequences;
and b. a light chain variable region comprising CDR1, CDR2, and CDR3 sequences, wherein the heavy chain variable region CDR3 sequence comprises an amino acid sequence chosen from SEQ ID NO.: 14, SEQ ID NO.: 22, SEQ ID NO.: 26, SEQ ID
NO.: 30 or SEQ ID NO.: 38, SEQ 10 N0:71, SEQ ID NO: 76, SEQ ID NO: 79 and conservative sequence modifications thereof and the light chain variable region CDR3 sequence comprises an amino acid sequence chosen from SEQ ID NOs: SEQ ID NO.: 16, SEQ ID NO.: 24, SEQ ID NO.: 28, SEQ ID NO.:
32 or SEQ ID NO.: 40, SEQ ID N0:85, SEQ ID NO: 93, and conservative sequence modifications thereof.

67. The method of any one of claims 1-66, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises a light chain variable region chosen from:
a. a light chain sequence comprising the sequence of SEQ ID NO:77, b. a light chain sequence comprising the sequence of SEQ ID NO:24, c. a light chain sequence comprising the sequence of SEQ ID NO:40; and d. a light chain sequence comprising the sequence of SEQ ID NO:28.

68. The method of any one of claims 1-67, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises the light chain sequence comprising SEQ ID NO:77.

69. The method of any one of claims 1-68, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises the light chain sequence comprising SEQ ID NO:24.

70. The method of any one of claims 1-69, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises a heavy chain variable region chosen from:
a. a heavy chain sequence comprising the sequence of SEQ ID NO:75, b. a heavy chain sequence comprising the sequence of SEQ ID NO:22, c. a heavy chain sequence comprising the sequence of SEQ ID NO:38; and d. a heavy chain sequence comprising the sequence of SEQ ID NO:26.

71. The method of any one of claims 1-70, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises the light chain sequence comprising SEQ ID NO:75.

72. The method of any one of claims 1-71, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises the light chain sequence comprising SEQ ID NO:22.

73. The method of any one of claims 1-72, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises a heavy chain variable region and a light chain variable region chosen from:
a. a light chain sequence comprising the sequence of SEQ ID NO:77 and a heavy chain sequence comprising the sequence of SEQ ID NO:75, b. a light chain sequence comprising the sequence of SEQ ID NO:24 and a heavy chain sequence comprising the sequence of SEQ ID NO:22, c. a light chain sequence comprising the sequence of SEQ ID NO:40 and a heavy chain sequence comprising the sequence of SEQ ID NO:38; and d. a light chain sequence comprising the sequence of SEQ ID NO:28 and a heavy chain sequence comprising the sequence of SEQ ID NO:26.

74. The method of any one of claims 1-73, wherein the .alpha.V.beta.6 targeted binding agent comprises an isolated antibody that binds .alpha.V.beta.6, wherein the antibody comprises:
a. a heavy chain variable region CDR1, CDR2, and CDR3 of SEQ ID NO:75; and b. a light chain variable region CDR1, CDR2 and CDR3 of SEQ ID NO:77.

75. A method of diagnosing breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of tumor cells overexpressing .alpha.V.beta.6 and HER2 by measuring the expression levels of .alpha.V.beta.6 and HER2, wherein the patient is diagnosed with breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition if .alpha.V.beta.6 and HER2 are both overexpressed.

76. A method for diagnosing and treating cancer sensitive to .alpha.V.beta.6 inhibition in a patient comprising analyzing a patient sample for the presence or absence of cancer cells overexpressing .alpha.V.beta.6 by measuring the levels of .alpha.V.beta.6, wherein the patient is diagnosed with cancer sensitive to .alpha.V.beta.6 inhibition if .alpha.V.beta.6 is overexpressed, and administering to the diagnosed patient a therapeutically effective dose of:
a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6.

77. The method of claim 76, wherein the method also comprises measuring the levels of HER2, wherein the patient is diagnosed with a cancer sensitive to HER2 inhibition if HER2 is overexpressed.

78. A method for diagnosing and treating breast cancer sensitive to HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of breast cancer cells overexpressing .alpha.V.beta.6 and HER2 by measuring the levels of the .alpha.V.beta.6 and HER2, wherein the patient is diagnosed with breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition if both .alpha.V.beta.6 and HER2 are overexpressed, and administering to the diagnosed patient a therapeutically effective dose of:
a. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

79. A method for diagnosing and treating breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition in a patient comprising analyzing a patient sample for the presence or absence of breast cancer cells overexpressing .alpha.V.beta.6 and HER2 by measuring the levels of the .alpha.V.beta.6 and HER2, wherein the patient is diagnosed with breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition if both .alpha.V.beta.6 and HER2 are overexpressed, and administering to the diagnosed patient a therapeutically effective dose of:
a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2.

80. A method for treating cancer sensitive to .alpha.V.beta.6 inhibition in a patient sample comprising requesting a test to determine whether a patient sample contains cancer cells overexpressing .alpha.V.beta.6, and administering a therapeutically effective dose of:
a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6 if the patient sample contains cancer cells overexpressing .alpha.V.beta.6.

81. A method for treating breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition in a patient sample comprising requesting a test to determine whether a patient sample contains cancer cells overexpressing .alpha.V.beta.6 and HER2, and administering a therapeutically effective dose of:
a. an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 and inhibits binding of ligands to .alpha.V.beta.6; and b. a HER2 targeted binding agent that specifically binds to HER2 and inhibits binding of ligands to HER2 if the patient sample contains cancer cells overexpressing .alpha.V.beta.6 and HER2.

82. The method of any one of claims 75-81, wherein the expression levels are measured by measuring protein expression.

83. The method of any one of claims 75-82, wherein the expression levels are measured by measuring mRNA expression.

84. The method of any one of claims 83, wherein the .alpha.V.beta.6 expression levels are measured by measuring mRNA expression of ITGB6.

85. The method of any one of claims 83-84, wherein the .alpha.V.beta.6 expression levels are elevated.

86. A method for diagnosing cancer sensitive to .alpha.V.beta.6 inhibition in a patient that can be treated by inhibiting .alpha.V.beta.6 comprising:

a. obtaining a biological sample from the subject;
b. applying an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 to the sample, wherein the presence of .alpha.V.beta.6 creates a .alpha.V.beta.6 targeted binding agent-.alpha.V.beta.6 complex;
c. diagnosing an aggressive form of breast cancer where the complex of step b) is detected at a level indicating .alpha.V.beta.6 overexpression.

87. A method for diagnosing breast cancer sensitive to .alpha.V.beta.6 and HER2 inhibition in a patient that can be treated by inhibiting .alpha.V.beta.6 and HER2 comprising:
a. obtaining a biological sample from the subject;
b. applying an .alpha.V.beta.6 targeted binding agent that specifically binds to .alpha.V.beta.6 to the sample, wherein the presence of .alpha.V.beta.6 creates a .alpha.V.beta.6 targeted binding agent-.alpha.V.beta.6 complex;
c. optionally applying a HER2 targeted binding agent that specifically binds to HER2 to the sample, wherein the presence of HER2 creates a HER2 binding agent-HER2 complex; and d. diagnosing an aggressive form of breast cancer where the complexes of steps b) and c) are detected at a level indicating .alpha.V.beta.6 and HER2 overexpression.

88. The method of any one of claims 75-87, wherein .alpha.V.beta.6 and/or HER2 are detected by the extent of tumor cell staining and/or the intensity of tumor cell staining.

89. The method of any one of claims 75-88, wherein .alpha.V.beta.6 and/or HER2 are detected by the extent of tumor cells staining using a scoring system where 0=0%, 1=<25%, 2=25-50%, 3=>50%-75%, and 4=>75%.

90. The method of any one of claims 75-89, wherein .alpha.V.beta.6 and/or HER2 are detected by an intensity of tumor cell staining score of 0=negative, 1=weak, 2=moderate, 3=strong.

91. The method of any one of claims 75-90, wherein the .alpha.V.beta.6 is quantified as overexpressed if it has a final score of >=5 when the score of extent of tumor cell staining and the score of intensity of staining in a scoring are added together.

92. The method of any one of claims 75-91, wherein the HER2 is quantified as overexpressed if it has a final score of >=5 when the score of extent of tumor cell staining and the score of intensity of staining in a scoring are added together.

93. The method of any one of claims 75-92, wherein each sample is scored by more than one pathologist and the scores are averaged.